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Lam WK, Law WYF, Wong TF, Woo VHK, Wu AHH, Chow EYD, Lau KN, Wong ACC, Yip SF. A specific early eluting peak in Bio-Rad Variant II cation-exchange high-performance liquid chromatography (CE-HPLC) for the screening of alpha-thalassaemia in a Chinese population. Pathology 2023; 55:835-842. [PMID: 37532658 DOI: 10.1016/j.pathol.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/07/2023] [Accepted: 05/30/2023] [Indexed: 08/04/2023]
Abstract
The early eluting peaks in the first minute of cation-exchange high-performance liquid chromatography (CE-HPLC) are often not analysed in haemoglobin pattern studies, except for haemoglobin (Hb) Bart's and Hb H peaks. In this study, we described the presence of a specific α-thalassaemia early eluting peak (αEEP) at the retention time of 0.24 min generated by Variant II CE-HPLC (β-Thalassaemia Short Program; Bio-Rad Laboratories). We have evaluated the utility of αEEP for the screening of α-thalassaemia trait in our local Chinese population in comparison to the Hb H inclusion body test. A total of 303 blood samples presenting with microcytosis were sent for haemoglobin pattern study and were analysed for the presence or absence of αEEP and Hb H inclusions. Twenty cases with a normal mean corpuscular volume were assessed as a control. Discordant results between the αEEP and the Hb H inclusion test were reviewed with the α-globin genotyping test performed. The concordance rate of the αEEP and the Hb H inclusion body test was 96.0% (κ=0.921, p<0.001). Eight of 303 cases (2.6%) were initially negative for the Hb H inclusion test but positive for the αEEP. All eight cases were found to have occasional Hb H inclusion bodies upon review. Four of 303 cases (1.3%) were negative for the αEEP but positive for the Hb H inclusion test. Of these four cases, two (50%) showed heterozygous Southeast Asian (SEA) type deletion, one (25%) showed Hb Quong Sze mutation, and one (25%) showed no mutation detected upon molecular testing. All the Hb E trait cases with no Hb H inclusions and the negative control group showed the absence of the αEEP. The sensitivity and specificity of αEEP for detecting SEA deletion were 93.8% and 100% respectively, which is superior to the Hb H inclusion test (sensitivity 81.3%, specificity 95.2%). The αEEP is found to be a more sensitive method than the Hb H inclusion body test in the screening of α-thalassaemia trait in our Chinese population, in which SEA type deletion is prevalent. Further study is needed to explore the utility of the αEEP in the screening of α-thalassaemia traits in other populations. The exact nature of the αEEP is yet to be defined.
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Affiliation(s)
- Wing Kit Lam
- Department of Clinical Pathology, Tuen Mun Hospital, Hong Kong.
| | | | - Tsz Fung Wong
- Department of Clinical Pathology, Tuen Mun Hospital, Hong Kong
| | | | | | | | - Ka Ngai Lau
- Department of Clinical Pathology, Tuen Mun Hospital, Hong Kong
| | | | - Sze Fai Yip
- Department of Clinical Pathology, Tuen Mun Hospital, Hong Kong
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Hunnuan I, Sanpkit K, Lertbannaphong O, Buaboonnam J. Hemoglobin H Disease and Growth: A Comparative Study of DHbH and NDHbH Patients. Mediterr J Hematol Infect Dis 2023; 15:e2023045. [PMID: 37705526 PMCID: PMC10497309 DOI: 10.4084/mjhid.2023.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/08/2023] [Indexed: 09/15/2023] Open
Abstract
Background Hemoglobin H disease (HbH), a hemoglobinopathy resulting from abnormal alpha globin genes, is classified into two categories: deletional HbH (DHbH) and non-deletional HbH (NDHbH). The alpha-mutation genotypes exhibit a range of clinical anemias, which differentially impact patient growth. Objectives This retrospective study assessed the growth of HbH patients at Siriraj Hospital, Mahidol University. Methods Patients diagnosed with HbH between January 2005 and April 2021 were analyzed using growth standard scores of the Thai Society for Pediatric Endocrinology (2022 version) and BMI-for-age Z scores of the World Health Organization. Growth failure was defined as a patient's height for age exceeding two standard deviations below the mean. Results Of the 145 HbH patients, 75 (51.7%) had NDHbH, with --SEA/αCSα being the most common genotype (70 patients; 93.3%). The mean baseline hemoglobin level was significantly lower in NDHbH patients than in DHbH patients (8.16 ± 0.93 g/dL vs. 9.51 ± 0.68 g/dL; P < 0.001). Splenomegaly and growth failure prevalences were higher in NDHbH patients (37.3% vs. 0%, with P < 0.001, and 22.7% vs. 8.6%, with P = 0.020, respectively). Multivariable analysis revealed splenomegaly > 3 cm was associated with growth failure (OR = 4.28; 95% CI, 1.19-15.39; P = 0.026). Conclusions NDHbH patients exhibited lower hemoglobin levels and more pronounced splenomegaly than DHbH patients. Growth failure can occur in both HbH types but appears more prevalent in NDHbH. Close monitoring of growth velocity is essential, and early treatment interventions may be required to prevent growth failure.
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Affiliation(s)
- Issanun Hunnuan
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kleebsabai Sanpkit
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ornsuda Lertbannaphong
- Division of Endocrinology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol. University, Bangkok, Thailand
| | - Jassada Buaboonnam
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Jiang F, Xu LL, Chen GL, Zhou JY, Li J, Tang XW, Zuo LD, Li DZ. Hematological Characteristics of Hb Constant Spring ( HBA2: c.427T>C) Carriers in Mainland China. Hemoglobin 2020; 44:86-88. [PMID: 32338097 DOI: 10.1080/03630269.2020.1755979] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Hb Constant Spring (Hb CS) (HBA2: c.427T>C) is a common α-globin variant causing α-thalassemia (α-thal) phenotypes in mainland China. In this study, we evaluated the efficiency of erythrocyte parameters and capillary electrophoresis (CE) in the determination of Hb CS in blood samples from Hb CS carriers. Based on molecular diagnosis, there were 462 patients carrying Hb CS: 411 Hb CS heterozygotes, seven carried Hb H-Hb CS disease, 18 compound heterozygotes for Hb CS/α+-thal, and 26 double heterozygotes for Hb CS and β-thalassemia (β-thal). Forty-three cases had no Hb CS peak visible on CE, including all 26 cases of double heterozygotes for Hb CS and β-thal, and 17 cases of heterozygotes carrying only Hb CS. Hb CS heterozygotes, those without a Hb CS peak, presented with lower hemoglobin (Hb), mean corpuscular volume (MCV) and mean corpuscular Hb (MCH) values than those with a Hb CS peak. The MCV <80.0 fL yielded a detection rate of 87.8% for screening individuals carrying Hb CS. Therefore, we emphasize that if one partner of a couple has tested positive for α0-thal, the other should be subjected to detailed screening for this nondeletional allele using molecular analysis, regardless of his/her red cell indices and electrophoretic chromatogram.
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Affiliation(s)
- Fan Jiang
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center affiliated to Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Li-Li Xu
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center affiliated to Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Gui-Lan Chen
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center affiliated to Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Jian-Ying Zhou
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center affiliated to Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Jian Li
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center affiliated to Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Xue-Wei Tang
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center affiliated to Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Lian-Dong Zuo
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center affiliated to Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Dong-Zhi Li
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center affiliated to Guangzhou Medical University, Guangzhou, People's Republic of China
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4
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Iranian patients with hemoglobin H disease: genotype–phenotype correlation. Mol Biol Rep 2019; 46:5041-5048. [DOI: 10.1007/s11033-019-04955-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/27/2019] [Indexed: 11/28/2022]
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Li Y, Liang L, Tian M, Qin T, Wu X. Detection of Hb H disease caused by a novel mutation and -- SEA deletion using capillary electrophoresis. J Clin Lab Anal 2019; 33:e22949. [PMID: 31199523 PMCID: PMC6757179 DOI: 10.1002/jcla.22949] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 05/20/2019] [Indexed: 11/11/2022] Open
Abstract
Background Hb H disease is a serious type of α‐thalassemia which cause moderate anemia while misdiagnosis by routine genetic analysis in a rare or novel Hb H disease. Methods The study was done on three patients and one fetus in a suspected Hb H disease family. Hb analysis was carried out using capillary electrophoresis (CE), and hematological analysis was conducted with an automated cell counter. Common α‐ and β‐thalassemia mutations were detected by routine genetic analysis (gap‐PCR and RDB‐PCR). Novel mutation diagnostic methods were based on DNA sequencing. Results Capillary electrophoresis revealed clinical feature of classic Hb H disease in the proband, and hematology analysis showed moderate anemia (Hb 87 g/L). But routine genetic analysis was found that it was only a heterozygote for the ‐‐SEA deletion. DNA sequencing of α‐globin genes (α1 and α2) identified the breakpoints between nts 34162 and 34171 at α2 gene, named CD 90‐93 (‐AGCTTCGG) mutation. The genotype of proband and fetus was the same ‐‐SEA/‐αCD90‐93. His father was homozygous for the novel mutation (‐αCD90‐93/‐αCD90‐93), and his mother was heterozygote for the ‐‐SEA deletion. Conclusions Our study for the first time described the novel mutation CD 90‐93 (‐AGCTTCGG). CE is a way to avoid misdiagnosis of rare or novel Hb H disease.
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Affiliation(s)
- Youqiong Li
- The Center of Reproduction and Genetic, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China.,The Center of Prenatal Diagnosis, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Liang Liang
- The Center of Prenatal Diagnosis, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Mao Tian
- The Center of Prenatal Diagnosis, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Ting Qin
- The Center of Prenatal Diagnosis, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Xin Wu
- The Center of Prenatal Diagnosis, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
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Zhao P, Wu H, Zhong Z, Lan L, Zeng M, Lin H, Wang H, Zheng Z, Su L, Guo W. Molecular prenatal diagnosis of alpha and beta thalassemia in pregnant Hakka women in southern China. J Clin Lab Anal 2018; 32:e22306. [PMID: 28771834 PMCID: PMC6816879 DOI: 10.1002/jcla.22306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 07/11/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND To date, there has been no systematic study of DNA-based prenatal diagnosis of thalassemia in pregnant Hakka women in southern China. METHODS A total of 279 pregnant Hakka women with confirmed cases of thalassemia who had been treated at the Meizhou People's Hospital in China's Guangdong Province from January 2014 to December 2016 were here enrolled. Genomic DNA was extracted from peripheral blood of couples and villus, amniotic fluid, or fetal cord blood. DNA-based diagnosis was performed on the tissues of fetuses whose parents had tested positive for α- and β-globin gene mutations were found using polymerase chain reaction (PCR) and flow-through hybridization technique. Follow-up visits were performed 6 months after the fetuses were born. Prenatal diagnosis was performed on 279 fetuses in at-risk pregnancies. RESULTS Here, 211 α-thalassemia fetuses were confirmed, including 41 (19.43%) that tested positive for Bart's hydrops syndrome and 15 (7.11%) for Hb H disease. There were 103 (48.81%) heterozygotes. β-thalassemia was confirmed in 68 fetuses, including 23 (33.82%) with severe thalassemia and 27 (39.71%) heterozygotes. Another 12 cases were confirmed with α+β-thalassemia, including three cases of severe β-thalassemia. DNA-based testing prenatal diagnosis of thalassemia was found to be highly reliable. CONCLUSIONS Our findings provide key information for clinical genetic counseling of prenatal diagnosis for major thalassemia in pregnant Hakka women in southern China.
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Affiliation(s)
- Pingsen Zhao
- Clinical Core LaboratoryMeizhou People's Hospital (Huangtang Hospital)Meizhou Hospital Affiliated to Sun Yat‐sen UniversityMeizhouChina
- Center for Precision MedicineMeizhou People's Hospital (Huangtang Hospital)Meizhou Hospital Affiliated to Sun Yat‐sen UniversityMeizhouChina
- Prenatal Diagnosis CenterMeizhou People's Hospital (Huangtang Hospital)Meizhou Hospital Affiliated to Sun Yat‐sen UniversityMeizhouChina
| | - Heming Wu
- Clinical Core LaboratoryMeizhou People's Hospital (Huangtang Hospital)Meizhou Hospital Affiliated to Sun Yat‐sen UniversityMeizhouChina
- Center for Precision MedicineMeizhou People's Hospital (Huangtang Hospital)Meizhou Hospital Affiliated to Sun Yat‐sen UniversityMeizhouChina
- Prenatal Diagnosis CenterMeizhou People's Hospital (Huangtang Hospital)Meizhou Hospital Affiliated to Sun Yat‐sen UniversityMeizhouChina
| | - Zhixiong Zhong
- Center for Precision MedicineMeizhou People's Hospital (Huangtang Hospital)Meizhou Hospital Affiliated to Sun Yat‐sen UniversityMeizhouChina
| | - Liubing Lan
- Prenatal Diagnosis CenterMeizhou People's Hospital (Huangtang Hospital)Meizhou Hospital Affiliated to Sun Yat‐sen UniversityMeizhouChina
- Department of ObstetricsMeizhou People's Hospital (Huangtang Hospital)Meizhou Hospital Affiliated to Sun Yat‐sen UniversityMeizhouChina
| | - Mei Zeng
- Prenatal Diagnosis CenterMeizhou People's Hospital (Huangtang Hospital)Meizhou Hospital Affiliated to Sun Yat‐sen UniversityMeizhouChina
- Department of ObstetricsMeizhou People's Hospital (Huangtang Hospital)Meizhou Hospital Affiliated to Sun Yat‐sen UniversityMeizhouChina
| | - Hualan Lin
- Prenatal Diagnosis CenterMeizhou People's Hospital (Huangtang Hospital)Meizhou Hospital Affiliated to Sun Yat‐sen UniversityMeizhouChina
- Department of ObstetricsMeizhou People's Hospital (Huangtang Hospital)Meizhou Hospital Affiliated to Sun Yat‐sen UniversityMeizhouChina
| | - Huaxian Wang
- Clinical Core LaboratoryMeizhou People's Hospital (Huangtang Hospital)Meizhou Hospital Affiliated to Sun Yat‐sen UniversityMeizhouChina
- Center for Precision MedicineMeizhou People's Hospital (Huangtang Hospital)Meizhou Hospital Affiliated to Sun Yat‐sen UniversityMeizhouChina
- Prenatal Diagnosis CenterMeizhou People's Hospital (Huangtang Hospital)Meizhou Hospital Affiliated to Sun Yat‐sen UniversityMeizhouChina
| | - Zhiyuan Zheng
- Clinical Core LaboratoryMeizhou People's Hospital (Huangtang Hospital)Meizhou Hospital Affiliated to Sun Yat‐sen UniversityMeizhouChina
- Center for Precision MedicineMeizhou People's Hospital (Huangtang Hospital)Meizhou Hospital Affiliated to Sun Yat‐sen UniversityMeizhouChina
- Prenatal Diagnosis CenterMeizhou People's Hospital (Huangtang Hospital)Meizhou Hospital Affiliated to Sun Yat‐sen UniversityMeizhouChina
| | - Luxian Su
- Clinical Core LaboratoryMeizhou People's Hospital (Huangtang Hospital)Meizhou Hospital Affiliated to Sun Yat‐sen UniversityMeizhouChina
- Center for Precision MedicineMeizhou People's Hospital (Huangtang Hospital)Meizhou Hospital Affiliated to Sun Yat‐sen UniversityMeizhouChina
- Prenatal Diagnosis CenterMeizhou People's Hospital (Huangtang Hospital)Meizhou Hospital Affiliated to Sun Yat‐sen UniversityMeizhouChina
| | - Wei Guo
- Clinical Core LaboratoryMeizhou People's Hospital (Huangtang Hospital)Meizhou Hospital Affiliated to Sun Yat‐sen UniversityMeizhouChina
- Center for Precision MedicineMeizhou People's Hospital (Huangtang Hospital)Meizhou Hospital Affiliated to Sun Yat‐sen UniversityMeizhouChina
- Prenatal Diagnosis CenterMeizhou People's Hospital (Huangtang Hospital)Meizhou Hospital Affiliated to Sun Yat‐sen UniversityMeizhouChina
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Pornprasert S, Salaeh NA, Tookjai M, Punyamung M, Pongpunyayuen P, Treesuwan K. Hematological Analysis in Thai Samples With Deletional and Nondeletional HbH Diseases. Lab Med 2018; 49:154-159. [DOI: 10.1093/labmed/lmx068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sakorn Pornprasert
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Nur-afsan Salaeh
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Monthathip Tookjai
- Associated Medical Sciences Clinical Service Center, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Manoo Punyamung
- Associated Medical Sciences Clinical Service Center, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Panida Pongpunyayuen
- Associated Medical Sciences Clinical Service Center, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Kallayanee Treesuwan
- Associated Medical Sciences Clinical Service Center, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
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8
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Cao J, He S, Pu Y, Liu J, Liu F, Feng J. Prenatal Diagnosis and Molecular Analysis of a Large Novel Deletion (– –JS) Causing α0-Thalassemia. Hemoglobin 2017; 41:243-247. [PMID: 29124980 DOI: 10.1080/03630269.2017.1374968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jinru Cao
- Prenatal Diagnosis Center, The Third People’s Hospital of Dongguan City, Guangdong Province, People’s Republic of China
| | - Shuzhen He
- Prenatal Diagnosis Center, The Third People’s Hospital of Dongguan City, Guangdong Province, People’s Republic of China
| | - Yudong Pu
- Prenatal Diagnosis Center, The Third People’s Hospital of Dongguan City, Guangdong Province, People’s Republic of China
| | - Jingjing Liu
- Yaneng BIOscience (Shenzhen) Co. Ltd., Shenzhen, Guandong Province, People’s Republic of China
| | - Fuping Liu
- Yaneng BIOscience (Shenzhen) Co. Ltd., Shenzhen, Guandong Province, People’s Republic of China
| | - Jun Feng
- School of Medicine, Guangxi University of Science and Technology, Liuzhou, Guangxi Zhuang Autonomous Region, People’s Republic of China
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9
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Surapolchai P, Chuansumrit A, Sirachainan N, Kadegasem P, Leung KC, So CC. A molecular study on the role of alpha-hemoglobin-stabilizing protein in hemoglobin H disease. Ann Hematol 2017; 96:1005-1014. [DOI: 10.1007/s00277-017-2978-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 03/09/2017] [Indexed: 11/24/2022]
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10
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So CC, Liu AK, Tsang MH, Ngai DY, Leung KS, Chan AY. Genetic basis of persistent red blood cell microcytosis in the Chinese unexplained by phenotypical testing. J Clin Pathol 2014; 68:69-72. [PMID: 25352644 DOI: 10.1136/jclinpath-2014-202568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS Hypochromic microcytic anaemia is the hallmark phenotype of thalassaemia. Current phenotypical tests do not provide a diagnosis in a small proportion of patients with red blood cell microcytosis. We aim to evaluate the genetic basis of red cell microcytosis in these cases in our Chinese population. METHODS We identified from a large cohort of 1684 unselected requests for thalassaemia testing 23 Chinese subjects who had unexplained microcytosis after phenotypical iron and haemoglobin studies. In 18 of these subjects with available DNA, extensive genotypical analysis of the α and β globin gene cluster was performed, including gap-PCR, multiplex amplification-refractory mutation system, Sanger sequencing and multiplex ligation-dependent probe amplification. RESULTS Occult single and double α globin gene (HBA1, HBA2) deletions and α thalassaemic haemoglobinopathies (Haemoglobin Quong Sze, Haemoglobin Constant Spring) were the genetic basis for the microcytosis. Occult β globin gene (HBB) mutations and δ globin gene (HBD) abnormalities masking β thalassaemia are not seen. CONCLUSIONS A cost-effective genotyping approach for the detection of these occult globin gene mutations can be proposed. The identification of these mutations is important for making a diagnosis and for the provision of accurate genetic counselling. (This paper adds to our understanding of the genetic basis of red blood cell microcytosis in clinical practice, and it provides a cost-effective approach for genotyping in diagnostic laboratories).
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Affiliation(s)
- Chi-Chiu So
- Department of Pathology, Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Ada K Liu
- Department of Pathology and Clinical Biochemistry, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Mandy H Tsang
- Department of Pathology and Clinical Biochemistry, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Donna Y Ngai
- Department of Pathology and Clinical Biochemistry, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Kin-Sang Leung
- Department of Pathology and Clinical Biochemistry, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Amy Y Chan
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong, Hong Kong
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Abstract
Thalassemia is the most common monogenic inherited disease worldwide and it affects most countries to various extents. This review summarizes the current approaches to phenotypic and genotypic diagnosis of thalassemia in clinical practice. Prevention strategies that encompass carrier screening, genetic counseling and prenatal diagnosis are discussed. The importance of public education and an awareness of a changing perception regarding this group of diseases are emphasized. It also addresses the impact of the rapidly increasing knowledge in disease severity modification by hemoglobin F (Hb F).
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Affiliation(s)
- Ho-Wan Ip
- Department of Pathology and Clinical Biochemistry, Queen Mary Hospital , Hong Kong SAR , China and
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12
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So CC, Chan AYY, Ma ESK. Novel Point Mutation of the α2-Globin Gene (HBA2) and a Rare 2.4 kb Deletion of the α1-Globin Gene (HBA1), Identified in Two Chinese Patients with Hb H Disease. Hemoglobin 2014; 38:213-5. [DOI: 10.3109/03630269.2014.894478] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Long J, Yan S, Lao K, Pang W, Ye X, Sun L. The diagnosis and molecular analysis of a novel 21.9kb deletion (Qinzhou type deletion) causing α+ thalassemia. Blood Cells Mol Dis 2014; 52:225-9. [DOI: 10.1016/j.bcmd.2013.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 10/10/2013] [Accepted: 10/15/2013] [Indexed: 11/25/2022]
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Mutations in Kruppel-like factor 1 cause transfusion-dependent hemolytic anemia and persistence of embryonic globin gene expression. Blood 2014; 123:1586-95. [PMID: 24443441 DOI: 10.1182/blood-2013-09-526087] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In this study, we report on 8 compound heterozygotes for mutations in the key erythroid transcription factor Krüppel-like factor 1 in patients who presented with severe, transfusion-dependent hemolytic anemia. In most cases, the red cells were hypochromic and microcytic, consistent with abnormalities in hemoglobin synthesis. In addition, in many cases, the red cells resembled those seen in patients with membrane defects or enzymopathies, known as chronic nonspherocytic hemolytic anemia (CNSHA). Analysis of RNA and protein in primary erythroid cells from these individuals provided evidence of abnormal globin synthesis, with persistent expression of fetal hemoglobin and, most remarkably, expression of large quantities of embryonic globins in postnatal life. The red cell membranes were abnormal, most notably expressing reduced amounts of CD44 and, consequently, manifesting the rare In(Lu) blood group. Finally, all tested patients showed abnormally low levels of the red cell enzyme pyruvate kinase, a known cause of CNSHA. These patients define a new type of severe, transfusion-dependent CNSHA caused by mutations in a trans-acting factor (Krüppel-like factor 1) and reveal an important pathway regulating embryonic globin gene expression in adult humans.
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Fang J, Chen L, Zeng R, Tian Q, Jiang W, Li H, Chen Z, Du C, Chen S. The Hb H Disease Genotypes in Southern China. Hemoglobin 2013; 38:76-8. [DOI: 10.3109/03630269.2013.855936] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Yang Y, Li DZ. CODON 30 (–GAG) (α2): Hematological Parameters in Heterozygotes and also Patients with Hb H Disease. Hemoglobin 2013; 37:599-603. [DOI: 10.3109/03630269.2013.812561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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17
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Dastidar R, Gajra B, De M. Molecular and Hematological Characterization of Hemoglobin H Disease in the Bengali Population of Kolkata, India. Genet Test Mol Biomarkers 2011; 15:93-6. [DOI: 10.1089/gtmb.2010.0062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rinini Dastidar
- Vivekananda Institute of Medical Sciences, Ramakrisna Mission Seva Pratisthan, Kolkata, India
| | - Bani Gajra
- Vivekananda Institute of Medical Sciences, Ramakrisna Mission Seva Pratisthan, Kolkata, India
| | - Madhusnata De
- Vivekananda Institute of Medical Sciences, Ramakrisna Mission Seva Pratisthan, Kolkata, India
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Wee YC, Tan KL, Chua KH, George E, Tan JAMA. Molecular characterisation of Haemoglobin Constant Spring and Haemoglobin Quong Sze with a Combine-Amplification Refractory Mutation System. Malays J Med Sci 2009; 16:21-28. [PMID: 22589661 PMCID: PMC3329134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2009] [Accepted: 07/19/2009] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND The interaction of the non-deletional α(+)-thalassaemia mutations Haemoglobin Constant Spring and Haemoglobin Quong Sze with the Southeast Asian double α-globin gene deletion results in non-deletional Haemoglobin H disease. Accurate detection of non-deletional Haemoglobin H disease, which is associated with severe phenotypes, is necessary as these mutations have been confirmed in the Malaysian population. METHODS DNA from two families with Haemoglobin H disease was extracted from EDTA-anticoagulated whole blood and subjected to molecular analysis for α-thalassaemia. A duplex polymerase chain reaction was used to detect the Southeast Asian α-globin gene deletion. Polymerase chain reaction-restriction fragment length polymorphism analysis was then carried out to determine the presence of Haemoglobin Constant Spring and Haemoglobin Quong Sze. A combine-amplification refractory mutation system protocol was optimised and implemented for the rapid and specific molecular characterisation of Haemoglobin Constant Spring and Haemoglobin Quong Sze in a single polymerase chain reaction. RESULTS AND CONCLUSIONS The combine-amplification refractory mutation system for Haemoglobin Constant Spring and Haemoglobin Quong Sze, together with the duplex polymerase chain reaction, provides accurate pre- and postnatal diagnosis of non-deletional Haemoglobin H disease and allows detailed genotype analyses using minimal quantities of DNA.
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Affiliation(s)
- Yong-Chui Wee
- Department of Molecular Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Kim-Lian Tan
- Department of Molecular Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Kek-Heng Chua
- Department of Molecular Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Elizabeth George
- Haematology Unit, Department of Pathology, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Jin-Ai Mary Anne Tan
- Department of Molecular Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Laosombat V, Viprakasit V, Chotsampancharoen T, Wongchanchailert M, Khodchawan S, Chinchang W, Sattayasevana B. Clinical features and molecular analysis in Thai patients with HbH disease. Ann Hematol 2009; 88:1185-92. [DOI: 10.1007/s00277-009-0743-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 04/01/2009] [Indexed: 11/28/2022]
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Diversity in clinical presentation of hemoglobin H disease induced by the SEA deletion and the hemoglobin Quong Sze. Ann Hematol 2009; 88:1145-7. [DOI: 10.1007/s00277-009-0716-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Accepted: 02/17/2009] [Indexed: 11/26/2022]
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Hb Q-H disease: two cases in a Cantonese family. Blood Cells Mol Dis 2008; 41:259-60. [PMID: 18653359 DOI: 10.1016/j.bcmd.2008.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Accepted: 06/16/2008] [Indexed: 11/21/2022]
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Li DZ, Liao C. A case of transfusion-dependent nondeletional Hb H disease undiagnosed during prenatal screening for thalassemia. Prenat Diagn 2008; 28:165-6. [DOI: 10.1002/pd.1947] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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