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El Osta M, Benoist JF, Naubourg P, Bonacorsi S, Messine R, Ducoroy P, Allaf B. MALDI-MS in first-line screening of newborns for sickle cell disease: results from a prospective study in comparison to HPLC. Clin Chem Lab Med 2024; 62:1149-1157. [PMID: 38353144 DOI: 10.1515/cclm-2023-1250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/23/2024] [Indexed: 04/30/2024]
Abstract
OBJECTIVES Newborn screening (NBS) for sickle cell disease (SCD) requires a robust, high-throughput method to detect hemoglobin S (HbS). Screening for SCD is performed by qualitative methods, such as isoelectric focusing (IEF), and both qualitative and quantitative methods such as high performance liquid chromatography (HPLC), capillary electrophoresis (CE), and tandem mass spectrometry (MS/MS). All these methods detect HbS, as well as low-level or absent HbA, and also other variants of hemoglobin. HPLC is considered as a reference method for NBS, because of its high sensitivity and specificity in detecting HbS. NeoSickle®, a fully automated matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) platform, combined with automated sample processing, a laboratory information management system and NeoSickle® software for automatic data interpretation, has increased the throughput of SCD testing. The purpose of this study was to compare the performances of NeoSickle® and HPLC. METHODS A prospective study was conducted including 9,571 samples from the NBS program to compare MALDI-MS using NeoSickle® with an HPLC method. Correlation between the two methods was studied. For the MALDI-MS method, sensitivity, specificity, NPV, and PPV were calculated. RESULTS We found over 99.4 % correlation between the HPLC and MALDI-MS results. NeoSickle® showed 100 % of sensitivity and specificity in detecting SCD syndrome, leading to positive and negative predictive values of 100 %. CONCLUSIONS NeoSickle® is adapted to NBS for SCD, and can be used in first-line high-throughput screening to detect HbS, and beta-thalassemia major warning. When HbS is detected, second-line use of another specific method as HPLC is necessary.
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Affiliation(s)
| | - Jean-François Benoist
- AP-HP, Hôpital Robert Debré, Service de Biochimie-Hormonologie, Paris, France
- Faculté de pharmacie, université Paris Saclay, Orsay, France
| | | | - Stéphane Bonacorsi
- Service de Microbiologie, AP-HP, Hôpital Robert Debré, Université de Paris, IAME, INSERM, Paris, France
| | - Reine Messine
- Service de Biochimie-Hormonologie, AP-HP, Hôpital Robert Debré, Unité de dépistage néonatal de la drépanocytose en Ile de France, Paris, France
| | | | - Bichr Allaf
- Service de Biochimie-Hormonologie, AP-HP, Hôpital Robert Debré, Unité de dépistage néonatal de la drépanocytose en Ile de France, Paris, France
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2
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Vuong C, Eckhardt CL, Heijboer H, Suijker MH, de Ligt LA, Voigt ALA, Leeflang MMG, Bartels M, Brons P, Hooimeijer L, Rettenbacher E, Smiers FJ, Stein-Wit MA, van der Veer A, Verbaan A, Cnossen MH, Fijnvandraat K. Long-term follow-up of children with sickle cell disease diagnosed by newborn screening in the Netherlands: Overview of morbidity and mortality. Am J Hematol 2024. [PMID: 38682156 DOI: 10.1002/ajh.27351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/10/2024] [Accepted: 04/15/2024] [Indexed: 05/01/2024]
Affiliation(s)
- Caroline Vuong
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Corien L Eckhardt
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Harriët Heijboer
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Monique H Suijker
- Center for Benign Hematology, Thrombosis and Hemostasis-Van Creveldkliniek, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Lydian A de Ligt
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Aimee L A Voigt
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Mariska M G Leeflang
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marije Bartels
- Center for Benign Hematology, Thrombosis and Hemostasis-Van Creveldkliniek, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Paul Brons
- Department of Pediatric Hematology, Amalia Children's Hospital, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Louise Hooimeijer
- Department of Pediatric Hematology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
| | - Eva Rettenbacher
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Frans J Smiers
- Department of Pediatric Hematology and Stem Cell Transplantation Unit, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands
| | - Marjet A Stein-Wit
- Department of Pediatric Hematology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
| | - Arian van der Veer
- Department of Pediatric Hematology, Mosakids Children's Hospital, Maastricht UMC+, Maastricht, the Netherlands
| | - Annemieke Verbaan
- Department of Pediatrics, Juliana Children's Hospital, Hagaziekenhuis, Den Haag, the Netherlands
| | - Marjon H Cnossen
- Department of Pediatric Hematology and Oncology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Karin Fijnvandraat
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Queiroz G, Monteiro C, Manco L, Relvas L, Trovoada MDJ, Leite A, Bento C. Sickle cell trait in São Tomé e Príncipe: a population-based prevalence study in women of reproductive age. BMC Public Health 2024; 24:850. [PMID: 38504224 PMCID: PMC10949760 DOI: 10.1186/s12889-024-17761-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/12/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Sickle Cell Disorder is Africa's most prevalent genetic disease. Yet, it remains a neglected condition, with high mortality under-five, and a lack of population-based studies in the region. This is the first of its kind in São Tomé e Príncipe, aiming to estimate the prevalence of sickle cell trait and other haemoglobin variants in women of reproductive age and its associated factors. METHODS We conducted a cluster survey in 35 neighbourhoods. Haemoglobin was assessed through point-of-care capillary electrophoresis or high-performance liquid chromatography, and sociodemographic data through questionnaires. The weighted prevalence of sickle cell trait (HbAS) and HbC carriers was estimated with a 95% confidence interval (95% CI). We calculated weighted prevalence ratios (95% CI) through robust Poisson regression for its association with age and individual and collective genetic heritage. FINDINGS The prevalence of sickle cell trait in women of reproductive age in São Tomé e Príncipe (n = 376) was 13.45% (95% CI: 9.05-19.00). The prevalence of HbC carriers was 8.00% (95% CI: 4.71-12.00). Older age and speaking Forro or Angolar were positively associated with having sickle cell trait. INTERPRETATION The prevalence of sickle cell trait in São Tomé e Príncipe ranks high in the West African region. The country should follow international guidelines, implementing newborn screening and comprehensive healthcare management.
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Affiliation(s)
- Guilherme Queiroz
- Centro de Investigação em Antropologia e Saúde (CIAS), Universidade de Coimbra, Coimbra, Portugal.
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Av. Padre Cruz, Lisboa, 1600 - 560, Portugal.
- Unidade de Saúde Pública, Unidade Local de Saúde da Região de Aveiro, Aveiro, Portugal.
| | | | - Licínio Manco
- Centro de Investigação em Antropologia e Saúde (CIAS), Universidade de Coimbra, Coimbra, Portugal
- Departamento de Ciências da Vida, Universidade de Coimbra, Coimbra, Portugal
| | - Luís Relvas
- Unidade Funcional Hematologia Molecular, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
| | | | - Andreia Leite
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Av. Padre Cruz, Lisboa, 1600 - 560, Portugal
- Department of Epidemiology, Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | - Celeste Bento
- Centro de Investigação em Antropologia e Saúde (CIAS), Universidade de Coimbra, Coimbra, Portugal
- Unidade Funcional Hematologia Molecular, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
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Rainho M, Melo Ferreira E. [Identifying Haemoglobinopathy Carriers in Portugal: Challenges and Considerations from a Primary Health Care Perspective]. ACTA MEDICA PORT 2024; 37:235-236. [PMID: 38373228 DOI: 10.20344/amp.20812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 12/22/2023] [Indexed: 02/21/2024]
Affiliation(s)
- Marta Rainho
- Medicina Geral e Familiar. Unidade de Saúde Familiar Luísa Todi. Unidade Local de Saúde da Arrábida. Setúbal. Portugal
| | - Elisa Melo Ferreira
- Medicina Geral e Familiar. Unidade de Saúde Familiar Luísa Todi. Unidade Local de Saúde da Arrábida. Setúbal. Portugal
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Tang H, Zhang N, Liu X, Xiao H, Zhang H, Zhou K, Deng J. Incidence Trends of Inherited Anemias at the Global, Regional, and National Levels Over Three Decades. J Epidemiol Glob Health 2024; 14:72-85. [PMID: 38079097 PMCID: PMC11043255 DOI: 10.1007/s44197-023-00170-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/14/2023] [Indexed: 04/25/2024] Open
Abstract
Inherited anemia continues to pose a significant public health concern on a global scale, owing to its extensive geographical prevalence, substantial patient population, and profound ramifications. Here, we investigated detailed information on inherited anemias (including thalassemias, thalassemias trait, sickle cell disease, sickle cell trait, G6PD deficiency, and G6PD trait) for the period 1990-2019 from the Global Burden of Disease study. Over the course of three decades, there has been a persistent rise in the incidence of inherited anemias worldwide, culminating in a total of 44,896,026 incident cases in 2019. However, the prevalence of inherited anemias has exhibited a consistent downward trend over successive years. Significantly, these inherited anemias primarily impact females, exhibiting a male-to-female ratio of 1:1.88. Among males, the most prevalent inherited anemia is G6PD deficiency, whereas G6PD trait prevails among females. The incidence rates of inherited anemias and their temporal trend exhibited significant variations across different regions, with Central Sub-Saharan Africa displaying the highest incidence rates and Central Latin America experiencing the most substantial decline. The findings of this study suggest a significant correlation between the Socio-Demographic index (SDI) and incidence rates of inherited anemias, particularly in regions with lower SDI levels such as Africa and South Asia. These results contribute valuable insights for the analysis of global trends in the burden of inherited anemias.
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Affiliation(s)
- Hongwei Tang
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, People's Republic of China
| | - Nan Zhang
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, People's Republic of China
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, 430061, People's Republic of China
| | - Xinlei Liu
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, People's Republic of China
| | - Hongbo Xiao
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, People's Republic of China
| | - Hanyue Zhang
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, People's Republic of China
| | - Kang Zhou
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, People's Republic of China.
| | - Jianchuan Deng
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, People's Republic of China.
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6
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Mahapatra B, Mukherjee N, Khatoon S, Bhattacharya P, Thubru E, John D. Cost-effectiveness of newborn screening for sickle cell disease: a systematic review protocol. JBI Evid Synth 2024:02174543-990000000-00267. [PMID: 38287736 DOI: 10.11124/jbies-23-00302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
OBJECTIVE The purpose of the systematic review is to assess the cost-effectiveness of targeted/selective newborn screening compared with universal screening for sickle cell disease across various countries and settings. INTRODUCTION The incidence of sickle cell disease is increasing worldwide and it is a widespread and potentially fatal hematologic disorder that affects thousands of newborns worldwide. The cost of newborn screening creates a burden on households and the economy. INCLUSION CRITERIA Studies will be eligible for inclusion in the review if they include cost-effectiveness studies of newborn screening for sickle cell disease comparing targeted/selective screening with universal screening. METHODS A preliminary search of MEDLINE (PubMed) was undertaken using MeSH terms, such as sickle cell disease, newborn, and economic evaluations. Two reviewers will screen the titles, abstracts, and full text independently against the inclusion criteria. Disagreements will be resolved by discussion or with a third reviewer. To assess methodological quality, the JBI checklist for economic evaluation will be used. Data will be extracted by 2 reviewers using a modified JBI data extraction form. The JBI dominance ranking matrix for economic evaluations will be used to summarize and compare the results. Cost-effectiveness will be measured on the basis of cost per test/case detected, quality-adjusted life years gained, or disability-adjusted life years averted. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) assessment will be conducted to evaluate the certainty of economic evidence, such as use of resources and expenditures, and to incorporate the results into the decision-making process. REVIEW REGISTRATION PROSPERO CRD42017057963.
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Affiliation(s)
- Biswajit Mahapatra
- Evidence Synthesis and Implementation for Indigenous Health: A JBI Affiliate Centre, Centre for Public Health Research, Manbhum Ananda Ashram Nityananda Trust (MANT), Kolkata, West Bengal, India
| | - Nirmalya Mukherjee
- Evidence Synthesis and Implementation for Indigenous Health: A JBI Affiliate Centre, Centre for Public Health Research, Manbhum Ananda Ashram Nityananda Trust (MANT), Kolkata, West Bengal, India
| | - Sajda Khatoon
- Evidence Synthesis and Implementation for Indigenous Health: A JBI Affiliate Centre, Centre for Public Health Research, Manbhum Ananda Ashram Nityananda Trust (MANT), Kolkata, West Bengal, India
| | - Paramita Bhattacharya
- Evidence Synthesis and Implementation for Indigenous Health: A JBI Affiliate Centre, Centre for Public Health Research, Manbhum Ananda Ashram Nityananda Trust (MANT), Kolkata, West Bengal, India
| | - Edakashwa Thubru
- Evidence Synthesis and Implementation for Indigenous Health: A JBI Affiliate Centre, Centre for Public Health Research, Manbhum Ananda Ashram Nityananda Trust (MANT), Kolkata, West Bengal, India
| | - Denny John
- Evidence Synthesis and Implementation for Indigenous Health: A JBI Affiliate Centre, Centre for Public Health Research, Manbhum Ananda Ashram Nityananda Trust (MANT), Kolkata, West Bengal, India
- M.S. Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
- School of Public Health, University of Adelaide, Adelaide, Australia
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7
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Shook LM, Ware RE. Screening for haemoglobin disorders: One size may not fit all. Br J Haematol 2024; 204:26-28. [PMID: 37877454 DOI: 10.1111/bjh.19160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 10/03/2023] [Indexed: 10/26/2023]
Abstract
Accurate laboratory screening for sickle cell disease and other haemoglobin disorders is expanding worldwide. Two new reports describe different methods and strategies for screening in Mali and Denmark, respectively, and their encouraging results suggest that countries should tailor their screening programmes according to local needs, resources and opportunities. Commentary on: Guindo et al. Potential for a large-scale newborn screening strategy for sickle cell disease in Mali: a comparative diagnostic performance study of two rapid diagnostic tests (SickleScan® and HemotypeSC®) on cord blood. Br J Haematol 2024;204:337-345 and Gravholt et al. The Danish national haemoglobinopathy screening programme: report from 16 years of screening in a low-prevalence, non-endemic region. Br J Haematol 2024;204:329-336.
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Affiliation(s)
- Lisa M Shook
- Division of Hematology, Department of Pediatrics, Cincinnati Children's Hospital Medical Centre, Cincinnati, Ohio, USA
- Comprehensive Sickle Cell Centre, Cincinnati Children's Hospital Medical Centre, Cincinnati, Ohio, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Russell E Ware
- Division of Hematology, Department of Pediatrics, Cincinnati Children's Hospital Medical Centre, Cincinnati, Ohio, USA
- Comprehensive Sickle Cell Centre, Cincinnati Children's Hospital Medical Centre, Cincinnati, Ohio, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- Global Health Centre, Cincinnati Children's Hospital Medical Centre, Cincinnati, Ohio, USA
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8
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Franco E, Karkoska KA, McGann PT. Inherited disorders of hemoglobin: A review of old and new diagnostic methods. Blood Cells Mol Dis 2024; 104:102758. [PMID: 37246072 DOI: 10.1016/j.bcmd.2023.102758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/17/2023] [Indexed: 05/30/2023]
Abstract
The genetic regulation of hemoglobin is complex and there are a number of genetic abnormalities that result in clinically important hemoglobin disorders. Here, we review the molecular pathophysiology of hemoglobin disorders and review both old and new methods of diagnosing these disorders. Timely diagnosis of hemoglobinopathies in infants is essential to coordinate optimal life-saving interventions, and accurate identification of carriers of deleterious mutations allows for genetic counseling and informed family planning. The initial laboratory workup of inherited disorders of hemoglobin should include a complete blood count (CBC) and peripheral blood smear, followed by carefully selected tests based on clinical suspicion and available methodology. We discuss the utility and limitations of the various methodologies to fractionate hemoglobin, including cellulose acetate and citrate agar hemoglobin electrophoresis, isoelectric focusing, high-resolution high-performance liquid chromatography, and capillary zone electrophoresis. Recognizing that most of the global burden of hemoglobin disorders exists in low- and middle-income countries, we review the increasingly available array of point-of-care-tests (POCT), which have an increasingly important role in expanding early diagnosis programs to address the global burden of sickle cell disease, including Sickle SCAN, HemoTypeSC, Gazelle Hb Variant, and Smart LifeLC. A comprehensive understanding of the molecular pathophysiology of hemoglobin and the globin genes, as well as a clear understanding of the utility and limitations of currently available diagnostic tests, is essential in reducing global disease burden.
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Affiliation(s)
- Emily Franco
- Warren Alpert Medical School of Brown University, Providence, RI, United States of America; Lifespan Comprehensive Sickle Cell Center at Hasbro Children's Hospital and Rhode Island Hospital, Providence, RI, United States of America
| | - Kristine A Karkoska
- Division of Hematology/Oncology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
| | - Patrick T McGann
- Warren Alpert Medical School of Brown University, Providence, RI, United States of America; Lifespan Comprehensive Sickle Cell Center at Hasbro Children's Hospital and Rhode Island Hospital, Providence, RI, United States of America.
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Gravholt EAE, Petersen J, Mottelson M, Nardo-Marino A, Rathe M, Olsen M, Holm C, Jørgensen FS, Birgens H, Glenthøj A. The Danish national haemoglobinopathy screening programme: Report from 16 years of screening in a low-prevalence, non-endemic region. Br J Haematol 2024; 204:329-336. [PMID: 37694757 DOI: 10.1111/bjh.19103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023]
Abstract
The Danish national haemoglobinopathy screening programme seeks to determine parental haemoglobinopathy carrier state antenatally. In this retrospective register-based study, we evaluated the 16-year trajectory of this programme, utilising the Danish Red Blood Cell Centre's laboratory database, covering approximately 77% of the Danish population. During the study period, we observed a substantial increase in annual diagnostic examinations performed, from 389 in 2007 to 3030 in 2022. Women constituted 88% of these cases, aligning with the emphasis of the screening programme. Of these, 54% of women of reproductive age (15-40 years) and 10% of women >40 years were specified as pregnant. During our study period, 61 children were born with a severe haemoglobinopathy, out of which 23 children were born from mothers not residing in Denmark during their first trimester thus not included in the screening programme. Prenatal invasive testing was performed for 60 fetuses, identifying 12 with homozygous or compound heterozygous haemoglobinopathy. The Danish haemoglobinopathy screening programme has provided screening, information and reproductive choices for numerous families. During the study period, screening for haemoglobinopathies has been steadily increasing and is expected to continue to increase. Awareness of and adherence to the screening programme is subject of further investigation and optimisation.
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Affiliation(s)
| | - Jesper Petersen
- Danish Red Blood Cell Centre, Department of Haematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Mathis Mottelson
- Danish Red Blood Cell Centre, Department of Haematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Amina Nardo-Marino
- Danish Red Blood Cell Centre, Department of Haematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Mathias Rathe
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Marianne Olsen
- Department of Paediatrics and Adolescent Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Charlotte Holm
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Finn Stener Jørgensen
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Fetal Medicine Unit, Department of Gynaecology and Obstetrics, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Henrik Birgens
- Danish Red Blood Cell Centre, Department of Haematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Andreas Glenthøj
- Danish Red Blood Cell Centre, Department of Haematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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10
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Wang X, McKillop WM, Dlugi TA, Faber ML, Alvarez-Argote J, Chambers CB, Wilber A, Medin JA. A mass spectrometry assay for detection of endogenous and lentiviral engineered hemoglobin in cultured cells and sickle cell disease mice. J Gene Med 2024; 26:e3567. [PMID: 37455676 DOI: 10.1002/jgm.3567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/16/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
Sickle cell disease (SCD) results from a sequence defect in the β-globin chain of adult hemoglobin (HbA) leading to expression of sickle hemoglobin (HbS). It is traditionally diagnosed by cellulose-acetate hemoglobin electrophoresis or high-performance liquid chromatography. While clinically useful, these methods have both sensitivity and specificity limitations. We developed a novel mass spectrometry (MS) method for the rapid, sensitive and highly quantitative detection of endogenous human β-globin and sickle hβ-globin, as well as lentiviral-encoded therapeutic hβAS3-globin in cultured cells and small quantities of mouse peripheral blood. The MS methods were used to phenotype homozygous HbA (AA), heterozygous HbA-HbS (AS) and homozygous HbS (SS) Townes SCD mice and detect lentiviral vector-encoded hβAS3-globin in transduced mouse erythroid cell cultures and transduced human CD34+ cells after erythroid differentiation. hβAS3-globin was also detected in peripheral blood 6 weeks post-transplant of transduced Townes SS bone marrow cells into syngeneic Townes SS mice and persisted for over 20 weeks post-transplant. As several genome-editing and gene therapy approaches for severe hemoglobin disorders are currently in clinical trials, this MS method will be useful for patient assessment before treatment and during follow-up.
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Affiliation(s)
- Xuejun Wang
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - William M McKillop
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Theresa A Dlugi
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mary L Faber
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Juliana Alvarez-Argote
- Department of Medicine, Division of Hematology-Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Christopher B Chambers
- Department of Medical Microbiology, Immunology and Cell Biology, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Andrew Wilber
- Department of Medical Microbiology, Immunology and Cell Biology, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Jeffrey A Medin
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Biochemistry, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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11
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Reggiani G, Boaro MP, Colombatti R. Prevention of neurovascular complications in children with Sickle Cell Disease in the real-world setting: What adult medicine physicians should know. Presse Med 2023; 52:104201. [PMID: 37939876 DOI: 10.1016/j.lpm.2023.104201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/05/2023] [Indexed: 11/10/2023] Open
Abstract
Neurovascular complications represent one of the most detrimental manifestations of Sickle Cell Disease (SCD), affecting many patients since infancy. They include overt stroke, silent cerebral infarcts and neurocognitive disorders. In fact, neurodevelopment can be impaired in children resulting in cognitive dysfunction in adults with SCD. This review is meant to resume the most recent guidelines about the prevention of SCD neurovascular complications and to highlight the open challenges in their implementation. Transcranial Doppler, Magnetic Resonance Imaging/Angiography and neurocognitive test are useful screening tools. Chronic transfusion regimen, hematopoietic stem cell transplantation and neurocognitive rehabilitation find indications in the context of primary and secondary prevention of neurovascular complications of SCD. However, international guidelines are often difficult to bring into the real world due to the lack of appropriate instruments and trained personnel. Many challenges have still to be faced to guarantee the best possible neurocognitive function to each child affected by SCD.
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Affiliation(s)
- Giulia Reggiani
- Department of Women's and Children's Health, University of Padua, Via Giustiniani, 3, 35128 Padua, Italy.
| | - Maria Paola Boaro
- Department of Women's and Children's Health, University of Padua, Via Giustiniani, 3, 35128 Padua, Italy
| | - Raffaella Colombatti
- Department of Women's and Children's Health, University of Padua, Via Giustiniani, 3, 35128 Padua, Italy
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12
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Norman FF, Gonzalez-Sanz M, Gullón-Peña B, Chamorro-Tojeiro S, Rosas M, Crespillo-Andujar C, Monge-Maillo B, Comeche B, Corbacho-Loarte MD, Arcas C, Peña I, Tenorio MC, Lopez-Vélez R, Pérez-Molina JA. Haemoglobinopathies in mobile populations from sub-Saharan Africa. J Travel Med 2023; 30:taad115. [PMID: 37615968 DOI: 10.1093/jtm/taad115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 08/25/2023]
Abstract
A frequency of HbS or haemoglobin C trait of 15% was found in a cohort of recently arrived, mainly asymptomatic, young sub-Saharan Africans, using a simple point-of-care screening test. Screening allows early diagnosis of haemoglobinopathies in vulnerable populations facilitating linkage to care, genetic counselling and implementation of treatment and prevention strategies.
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Affiliation(s)
- Francesca F Norman
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Universidad de Alcalá, CIBER de Enfermedades Infecciosas, Madrid 28034, Spain
| | - Marta Gonzalez-Sanz
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Universidad de Alcalá, CIBER de Enfermedades Infecciosas, Madrid 28034, Spain
| | - Beatriz Gullón-Peña
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Universidad de Alcalá, CIBER de Enfermedades Infecciosas, Madrid 28034, Spain
| | - Sandra Chamorro-Tojeiro
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Universidad de Alcalá, CIBER de Enfermedades Infecciosas, Madrid 28034, Spain
| | - Marta Rosas
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Universidad de Alcalá, CIBER de Enfermedades Infecciosas, Madrid 28034, Spain
| | - Clara Crespillo-Andujar
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Universidad de Alcalá, CIBER de Enfermedades Infecciosas, Madrid 28034, Spain
| | - Begoña Monge-Maillo
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Universidad de Alcalá, CIBER de Enfermedades Infecciosas, Madrid 28034, Spain
| | - Belen Comeche
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Universidad de Alcalá, CIBER de Enfermedades Infecciosas, Madrid 28034, Spain
| | - Maria-Dolores Corbacho-Loarte
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Universidad de Alcalá, CIBER de Enfermedades Infecciosas, Madrid 28034, Spain
| | - Cristina Arcas
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Universidad de Alcalá, CIBER de Enfermedades Infecciosas, Madrid 28034, Spain
| | - Ignacio Peña
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Universidad de Alcalá, CIBER de Enfermedades Infecciosas, Madrid 28034, Spain
| | - Maria C Tenorio
- Hematology Department, Ramón y Cajal University Hospital, IRYCIS, Madrid 28034, Spain
| | - Rogelio Lopez-Vélez
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Universidad de Alcalá, CIBER de Enfermedades Infecciosas, Madrid 28034, Spain
| | - Jose A Pérez-Molina
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Universidad de Alcalá, CIBER de Enfermedades Infecciosas, Madrid 28034, Spain
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13
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Janda J, Hegert S, Bzdok J, Tesorero R, Holtkamp U, Burggraf S, Schuhmann E, Hörster F, Hoffmann GF, Janzen N, Okun JG, Becker M, Durner J. High Throughput Newborn Screening for Sickle Cell Disease - Application of Two-Tiered Testing with a qPCR-Based Primary screen. Klin Padiatr 2023; 235:366-372. [PMID: 37748509 PMCID: PMC10635756 DOI: 10.1055/a-2153-7789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) is a group of hemoglobinopathies with a common point mutation causing the production of sickle cell hemoglobin (HbS). In high-throughput newborn screening (NBS) for SCD, a two-step procedure is suitable, in which qPCR first pre-selects relevant samples that are differentiated by a second method. METHODS Three NBS centers using qPCR-based primary screening for SCD performed a laboratory comparison. Methods using tandem MS or HPLC were used for differentiation. RESULTS In a benchmarking test, 450 dried blood samples were analyzed. Samples containing HbS were detected as reliably by qPCR as by methods established for hemoglobinopathy testing. In a two-step screening approach, the 2nd-tier-analyses have to distinguish the carrier status from pathological variants. In nine months of regular screening, a total of 353,219 samples were analyzed using two-stage NBS procedures. The 1st-tier screening by qPCR reduced the number of samples for subsequent differentiation by>99.5%. Cases with carrier status or other variants were identified as inconspicuous while 78 cases with SCD were revealed. The derived incidence of 1:4,773, is in good agreement with previously published incidences. CONCLUSION In high-throughput NBS for SCD, qPCR is suitable to focus 2nd-tier analyses on samples containing HbS, while being unaffected by factors such as prematurity or transfusions. The substantial reduction of samples numbers positively impacts resource conservation, sustainability, and cost-effectiveness. No false negative cases came to attention.
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Affiliation(s)
- Joachim Janda
- Department of General Pediatrics, Division of Neuropediatrics and
Metabolic Medicine, University Hospital Heidelberg Center of Paediatric and
Adolescent Medicine, Heidelberg, Germany
| | | | | | - Rafael Tesorero
- Department of General Pediatrics, Division of Neuropediatrics and
Metabolic Medicine, University Hospital Heidelberg Center of Paediatric and
Adolescent Medicine, Heidelberg, Germany
| | - Ute Holtkamp
- Screening-Laboratory Hannover, Hannover, Germany
| | | | | | - Friedrike Hörster
- Department of General Pediatrics, Division of Neuropediatrics and
Metabolic Medicine, University Hospital Heidelberg Center of Paediatric and
Adolescent Medicine, Heidelberg, Germany
| | - Georg F. Hoffmann
- Department of General Pediatrics, Division of Neuropediatrics and
Metabolic Medicine, University Hospital Heidelberg Center of Paediatric and
Adolescent Medicine, Heidelberg, Germany
| | - Nils Janzen
- Screening-Laboratory Hannover, Hannover, Germany
- Dept. of Clinical Chemistry, Hannover Medical School, Hannover,
Germany
- Division of Laboratory Medicine, Kinderkrankenhaus auf der Bult,
Hannover, Germany
| | - Jürgen G Okun
- Department of General Pediatrics, Division of Neuropediatrics and
Metabolic Medicine, University Hospital Heidelberg Center of Paediatric and
Adolescent Medicine, Heidelberg, Germany
| | - Marc Becker
- Laboratory Becker & Colleagues, Munich, Germany
- Department of Conservative Dentistry and Periodontology, Ludwig
Maximilians University Munich, Munich, Germany
| | - Jürgen Durner
- Laboratory Becker & Colleagues, Munich, Germany
- Department of Conservative Dentistry and Periodontology, Ludwig
Maximilians University Munich, Munich, Germany
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14
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Hardouin G, Magrin E, Corsia A, Cavazzana M, Miccio A, Semeraro M. Sickle Cell Disease: From Genetics to Curative Approaches. Annu Rev Genomics Hum Genet 2023; 24:255-275. [PMID: 37624668 DOI: 10.1146/annurev-genom-120122-081037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
Sickle cell disease (SCD) is a monogenic blood disease caused by a point mutation in the gene coding for β-globin. The abnormal hemoglobin [sickle hemoglobin (HbS)] polymerizes under low-oxygen conditions and causes red blood cells to sickle. The clinical presentation varies from very severe (with acute pain, chronic pain, and early mortality) to normal (few complications and a normal life span). The variability of SCD might be due (in part) to various genetic modulators. First, we review the main genetic factors, polymorphisms, and modifier genes that influence the expression of globin or otherwise modulate the severity of SCD. Considering SCD as a complex, multifactorial disorder is important for the development of appropriate pharmacological and genetic treatments. Second, we review the characteristics, advantages, and disadvantages of the latest advances in gene therapy for SCD, from lentiviral-vector-based approaches to gene-editing strategies.
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Affiliation(s)
- Giulia Hardouin
- Laboratory of Chromatin and Gene Regulation During Development, Imagine Institute, INSERM UMR 1163, Université Paris Cité, Paris, France; ,
- Centre d'Investigation Clinique Spécialisé en Biothérapie, Département de Biothérapie, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; ,
- Human Lymphohematopoiesis Laboratory, Imagine Institute, INSERM UMR 1163, Université Paris Cité, Paris, France;
| | - Elisa Magrin
- Centre d'Investigation Clinique Spécialisé en Biothérapie, Département de Biothérapie, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; ,
| | - Alice Corsia
- Human Lymphohematopoiesis Laboratory, Imagine Institute, INSERM UMR 1163, Université Paris Cité, Paris, France;
| | - Marina Cavazzana
- Centre d'Investigation Clinique Spécialisé en Biothérapie, Département de Biothérapie, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; ,
- Imagine Institute, INSERM UMR 1163, Université Paris Cité, Paris, France
- Université Paris Cité, Paris, France
| | - Annarita Miccio
- Laboratory of Chromatin and Gene Regulation During Development, Imagine Institute, INSERM UMR 1163, Université Paris Cité, Paris, France; ,
| | - Michaela Semeraro
- Université Paris Cité, Paris, France
- Centre d'Investigation Clinique and Unité de Recherche Clinique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France;
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15
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Colombatti R, Hegemann I, Medici M, Birkegård C. Systematic Literature Review Shows Gaps in Data on Global Prevalence and Birth Prevalence of Sickle Cell Disease and Sickle Cell Trait: Call for Action to Scale Up and Harmonize Data Collection. J Clin Med 2023; 12:5538. [PMID: 37685604 PMCID: PMC10488271 DOI: 10.3390/jcm12175538] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
Sickle cell disease (SCD) is an inherited monogenic disorder with high prevalence throughout sub-Saharan Africa, the Mediterranean basin, the Middle East, and India. Sources of SCD epidemiology remain scarce and fragmented. A systematic literature review (SLR) to identify peer-reviewed studies on SCD epidemiology was performed, with a search of bibliographic databases and key conference proceedings from 1 January 2010 to 25 March 2022 (congress abstracts after 2018). The SLR followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Meta-analyses, using a binomial normal random-effects model, were performed to estimate global and regional prevalence and birth prevalence. Of 1770 journal articles and 468 abstracts screened, 115 publications met the inclusion criteria. Prevalence was highest in Africa (~800/100,000), followed by the Middle East (~200/100,000) and India (~100/100,000), in contrast to ~30/100,000 in Europe. Birth prevalence was highest in Africa (~1000/100,000) and lowest in North America (~50/100,000) and Europe (~30/100,000). This SLR confirmed that sub-Saharan and North-East Africa, India, the Middle East, and the Caribbean islands are global SCD hotspots. Publications including mortality data were sparse, and no conclusions could be drawn about mortality. The identified data were limited due to gaps in the published literature for large parts of the world population; the inconsistent reporting of SCD genotypes, diagnostic criteria, and settings; and a sparsity of peer-reviewed publications from countries with assumed high prevalence. This SLR demonstrated a lack of systematic knowledge and a need to provide uniform data collection on SCD prevalence and mortality.
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Affiliation(s)
- Raffaella Colombatti
- Clinic of Pediatric Hematology Oncology, Department of Child and Maternal Health, Azienda Ospedaliera, University of Padova, 35122 Padua, Italy
| | | | - Morten Medici
- Novo Nordisk A/S, 2860 Søborg, Denmark; (M.M.); (C.B.)
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16
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Piel FB, Rees DC, DeBaun MR, Nnodu O, Ranque B, Thompson AA, Ware RE, Abboud MR, Abraham A, Ambrose EE, Andemariam B, Colah R, Colombatti R, Conran N, Costa FF, Cronin RM, de Montalembert M, Elion J, Esrick E, Greenway AL, Idris IM, Issom DZ, Jain D, Jordan LC, Kaplan ZS, King AA, Lloyd-Puryear M, Oppong SA, Sharma A, Sung L, Tshilolo L, Wilkie DJ, Ohene-Frempong K. Defining global strategies to improve outcomes in sickle cell disease: a Lancet Haematology Commission. Lancet Haematol 2023; 10:e633-e686. [PMID: 37451304 DOI: 10.1016/s2352-3026(23)00096-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/31/2023] [Accepted: 04/12/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Frédéric B Piel
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
| | - David C Rees
- Department of Paediatric Haematology, King's College London, King's College Hospital, London, UK
| | - Michael R DeBaun
- Department of Pediatrics, Vanderbilt-Meharry Center of Excellence for Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Obiageli Nnodu
- Department of Haematology and Blood Transfusion, College of Health Sciences and Centre of Excellence for Sickle Cell Disease Research and Training, University of Abuja, Abuja, Nigeria
| | - Brigitte Ranque
- Department of Internal Medicine, Georges Pompidou European Hospital, Assistance Publique-Hopitaux de Paris Centre, University of Paris Cité, Paris, France
| | - Alexis A Thompson
- Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Russell E Ware
- Division of Hematology and Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Miguel R Abboud
- Department of Pediatrics and Adolescent Medicine, and Sickle Cell Program, American University of Beirut, Beirut, Lebanon
| | - Allistair Abraham
- Division of Blood and Marrow Transplantation, Children's National Hospital, Washington, DC, USA
| | - Emmanuela E Ambrose
- Department of Paediatrics and Child Health, Bugando Medical Centre, Mwanza, Tanzania
| | - Biree Andemariam
- New England Sickle Cell Institute, University of Connecticut Health, Connecticut, USA
| | - Roshan Colah
- Department of Haematogenetics, Indian Council of Medical Research National Institute of Immunohaematology, Mumbai, India
| | - Raffaella Colombatti
- Pediatric Oncology Hematology Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Nicola Conran
- Department of Clinical Medicine, School of Medical Sciences, Center of Hematology and Hemotherapy (Hemocentro), University of Campinas-UNICAMP, Campinas, Brazil
| | - Fernando F Costa
- Department of Clinical Medicine, School of Medical Sciences, Center of Hematology and Hemotherapy (Hemocentro), University of Campinas-UNICAMP, Campinas, Brazil
| | - Robert M Cronin
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Mariane de Montalembert
- Department of Pediatrics, Necker-Enfants Malades Hospital, Assistance Publique-Hopitaux de Paris Centre, Paris, France
| | - Jacques Elion
- Paris Cité University and University of the Antilles, Inserm, BIGR, Paris, France
| | - Erica Esrick
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Anthea L Greenway
- Department Clinical Haematology, Royal Children's Hospital, Parkville and Department Haematology, Monash Health, Clayton, VIC, Australia
| | - Ibrahim M Idris
- Department of Hematology, Aminu Kano Teaching Hospital/Bayero University Kano, Kano, Nigeria
| | - David-Zacharie Issom
- Department of Business Information Systems, School of Management, HES-SO University of Applied Sciences and Arts of Western Switzerland, Geneva, Switzerland
| | - Dipty Jain
- Department of Paediatrics, Government Medical College, Nagpur, India
| | - Lori C Jordan
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zane S Kaplan
- Department of Clinical Haematology, Monash Health and Monash University, Melbourne, VIC, Australia
| | - Allison A King
- Departments of Pediatrics and Internal Medicine, Divisions of Pediatric Hematology and Oncology and Hematology, Washington University School of Medicine, St Louis, MO, USA
| | - Michele Lloyd-Puryear
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Samuel A Oppong
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Accra, Ghana
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Leon Tshilolo
- Institute of Biomedical Research/CEFA Monkole Hospital Centre and Official University of Mbuji-Mayi, Mbuji-Mayi, Democratic Republic of the Congo
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | - Kwaku Ohene-Frempong
- Division of Hematology, Children's Hospital of Philadelphia, Pennsylvania, USA; Sickle Cell Foundation of Ghana, Kumasi, Ghana
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17
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Mañú Pereira MDM, Colombatti R, Alvarez F, Bartolucci P, Bento C, Brunetta AL, Cela E, Christou S, Collado A, de Montalembert M, Dedeken L, Fenaux P, Galacteros F, Glenthøj A, Gutiérrez Valle V, Kattamis A, Kunz J, Lobitz S, McMahon C, Pellegrini M, Reidel S, Russo G, Santos Freire M, van Beers E, Kountouris P, Gulbis B. Sickle cell disease landscape and challenges in the EU: the ERN-EuroBloodNet perspective. Lancet Haematol 2023:S2352-3026(23)00182-5. [PMID: 37451300 DOI: 10.1016/s2352-3026(23)00182-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023]
Abstract
Sickle cell disease is a hereditary multiorgan disease that is considered rare in the EU. In 2017, the Rare Diseases Plan was implemented within the EU and 24 European Reference Networks (ERNs) were created, including the ERN on Rare Haematological Diseases (ERN-EuroBloodNet), dedicated to rare haematological diseases. This EU initiative has made it possible to accentuate existing collaborations and create new ones. The project also made it possible to list all the needs of people with rare haematological diseases not yet covered health-care providers in the EU to allow optimised care of individuals with rare pathologies, including sickle cell disease. This Viewpoint is the result of joint work within 12 EU member states (ie, Belgium, Cyprus, Denmark, France, Germany, Greece, Ireland, Italy, Portugal, Spain, Sweden, and The Netherlands), all members of the ERN-EuroBloodNet. We describe the role of the ERN-EuroBloodNet to improve the overall approach to and the management of individuals with sickle cell disease in the EU through specific on the pooling of expertise, knowledge, and best practices; the development of training and education programmes; the strategy for systematic gathering and standardisation of clinical data; and its reuse in clinical research. Epidemiology and research strategies from ongoing implementation of the Rare Anaemia Disorders European Epidemiological Platform is depicted.
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Affiliation(s)
- María Del Mar Mañú Pereira
- Rare Anemia Disorders Research Laboratory, Cancer and Blood Disorders in Children, Vall d'Hebrón Institut de Recerca, Barcelona, Spain; Pediatric Hematology and Oncology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | - Raffaella Colombatti
- Pediatric Hematology Oncology Unit, Department of Women's and Child's Health, Azienda Ospedale-Università degli Studi di Padova, Padua, Italy
| | - Federico Alvarez
- Information Processing and Telecommunications Center, Universidad Politécnica de Madrid, Madrid, Spain
| | - Pablo Bartolucci
- Sickle Cell and Red Cell Disorders Referral Center-UMGGR, Hôpitaux Universitaires Henri Mondor, Assistance Publique Hôpitaux de Paris, Université Paris Est Créteil, Créteil, France; Institut Mondor de Recherche Biomédicale, Laboratory of Excellence LABEX GRex, Créteil, France
| | - Celeste Bento
- Hematology Department, University Hospital, Research Centre for Anthropology and Health (CIAS), University Coimbra, Coimbra, Portugal
| | - Angelo Loris Brunetta
- Thalassaemia International Federation, Nicosia, Cyprus; ERN-EuroBloodNet, Paris, France
| | - Elena Cela
- Pediatric Hematology and Oncology Unit, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Anna Collado
- Rare Anemia Disorders Research Laboratory, Cancer and Blood Disorders in Children, Vall d'Hebrón Institut de Recerca, Barcelona, Spain; Pediatric Hematology and Oncology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Mariane de Montalembert
- Department of General Pediatrics and Pediatric Infectious Disease, Sickle Cell Center, Necker-Enfants malades Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Laurence Dedeken
- Haemato-oncology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre Fenaux
- Département d'hématologie et immunologie, hôpital St Louis, Assistance Publique Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - Frédéric Galacteros
- Red Cell Genetic Disease Unit, Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris, GHU Henri Mondor; U-PEC, Paris, France
| | - Andreas Glenthøj
- Department of Hematology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Victoria Gutiérrez Valle
- Rare Anemia Disorders Research Laboratory, Cancer and Blood Disorders in Children, Vall d'Hebrón Institut de Recerca, Barcelona, Spain; Pediatric Hematology and Oncology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Antonis Kattamis
- Thalassemia Unit, First Department of Pediatrics, National and Kapodistrian University of Athens-'Aghia Sophia' Children's Hospital, Athens, Greece
| | - Joachim Kunz
- Department of Pediatric Oncology, Hematology, Oncology and Immunology, University of Heidelberg, Heidelberg, Germany
| | - Stephan Lobitz
- Department of Pediatric Hematology and Oncology, Gemeinschaftsklinikum Mittelrhein, Koblenz, Germany
| | - Corrina McMahon
- Department of Haematology, Children's Health Ireland at Crumlin, University College Dublin, Ireland
| | - Mariangela Pellegrini
- Département d'hématologie et immunologie, hôpital St Louis, Assistance Publique Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - Sara Reidel
- Rare Anemia Disorders Research Laboratory, Cancer and Blood Disorders in Children, Vall d'Hebrón Institut de Recerca, Barcelona, Spain; Pediatric Hematology and Oncology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Giovanna Russo
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Miriam Santos Freire
- ERN-EuroBloodNet, Paris, France; Associação Portuguesa de Pais e Doentes com Hemoglobinopatias-APPDH, Almada, Portugal; European Hematology Association, The Hague, Netherlands; Portugal for the European Sickle Cell Federation, Brussels, Belgium
| | - Eduard van Beers
- Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Petros Kountouris
- Molecular Genetics Thalassaemia Department, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Béatrice Gulbis
- Laboratoire Hospitalier Universitaire de Bruxelles, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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18
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Belle Jarvis S, Hadeed E, Lee K, Hardy-dessources M, Knight-madden JM, Richardson C. Sickle Cell Disease Newborn Screening—An Audit of a Twin Island State Pilot Program. Int J Neonatal Screen 2023; 9:14. [PMID: 36975852 PMCID: PMC10052052 DOI: 10.3390/ijns9010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/21/2023] [Accepted: 02/24/2023] [Indexed: 03/05/2023] Open
Abstract
The prevalence of Sickle Cell Disease (SCD) within the Caribbean region remains second only to that of West Africa. The Newborn Screening (NBS) Program in Antigua and Barbuda remains heavily dependent on grants, therefore ultimately facing sustainability challenges. Early intervention and implementation of preventative measures post-NBS result in significant improvements in morbidity, quality of life, and survival. This audit reviewed the pilot SCD NBS Program in Antigua and Barbuda from September 2020 to December 2021. A conclusive result was received by 99% of babies eligible for screening, 84.3% of which were HbFA, whilst 9.6% and 4.6% were HbFAS and HbFAC, respectively. This was comparable to other Caribbean countries. Sickle Cell Disease was noted in 0.5% of babies screened, which translates to 1 in 222 live births. Eighty-two percent of mothers were aware of their sickle cell status, compared to 3% of fathers. The importance of instituting a quality improvement team post the initiation of a screening program and the need for a robust public education program have been demonstrated by this audit.
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Núñez-Jurado D, Payán-Pernía S, Álvarez-Ríos AI, Jiménez-Jambrina M, Concepcion Pérez-De-Soto I, José Palma-Vallellano A, Zapata-Bautista R, Carlos Hernández-Castellet J, Paz Garrastazul-Sánchez M, Arqueros-Martínez V, Urbano-Ramos MDM, Abdelkader-Maanan M, Raúl García-Lozano J, Delgado-Pecellín C. Neonatal Screening for Sickle Cell Disease in Western Andalusia: Results and Lessons Learnt after 3 Years of Implementation. Am J Perinatol 2022. [PMID: 36580977 DOI: 10.1055/s-0042-1759646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of this study was to present the results obtained in the Newborn Screening Program (NSP) for sickle cell disease (SCD) in western Andalusia and the autonomous city of Ceuta in the first 3 years of implementation, and to describe the discrepancies found in the diagnosis of hemoglobinopathies between the screening method and the confirmatory tests. STUDY DESIGN A descriptive and retrospective study was carried out, and the findings obtained in the newborns included in the NSP between November 2018 and December 2021 were analyzed. RESULTS A total of 111,205 samples were screened by high-performance liquid chromatography (HPLC). The birth prevalence of SCD, sickle cell trait, hemoglobin C carriers, and the compound heterozygosity Hb C/β-thalassemia was 1/12,356, 1/467, 1/1,278, and 1/55,602 newborns, respectively. Although there was a correlation between the first-line HPLC screening technique (VARIANTnbs HPLC analyzer, Bio-Rad) and the confirmatory tests in most cases, major discrepancies were found in detecting carriers of G-Philadelphia, D, E, and O-Arab hemoglobin variants, with the former having an incidence of 1/10,110 and the others 1/22,241. The carrier status of Hb G-Philadelphia produced an FAD pattern on the screening method that could be mistaken as Hb D, while Hb O-Arab was identified as an FA5 pattern. Hb D was initially recognized as Hb D in two cases. CONCLUSION An NSP requires at least two different combined methods in order to identify the hemoglobin variant with sufficient certainty. Furthermore, even though software solutions for HPLC suggest a pattern, it must be confirmed with another technique to obtain a correct interpretation of the chromatograms. KEY POINTS · The NSPs are an essential activity in preventive medicine.. · At least two different combined methods are required to correctly identify hemoglobin variants.. · Different variants can produce a similar or identical pattern by a single method..
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Affiliation(s)
- David Núñez-Jurado
- Clinical Biochemistry Department, Virgen del Rocío University Hospital, Institute of Biomedicine of Seville (IBiS/CSIC), Seville, Spain
| | - Salvador Payán-Pernía
- Red Blood Cell Disorders Unit, Hematology Department, Virgen del Rocío University Hospital, Institute of Biomedicine of Seville (IBiS/CSIC), Seville, Spain
- Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana I Álvarez-Ríos
- Clinical Biochemistry Department, Virgen del Rocío University Hospital, Institute of Biomedicine of Seville (IBiS/CSIC), Seville, Spain
| | - Margarita Jiménez-Jambrina
- Red Blood Cell Disorders Unit, Hematology Department, Virgen del Rocío University Hospital, Institute of Biomedicine of Seville (IBiS/CSIC), Seville, Spain
| | - Inmaculada Concepcion Pérez-De-Soto
- Red Blood Cell Disorders Unit, Hematology Department, Virgen del Rocío University Hospital, Institute of Biomedicine of Seville (IBiS/CSIC), Seville, Spain
| | | | | | | | | | | | | | | | | | - Carmen Delgado-Pecellín
- Clinical Biochemistry Department, Virgen del Rocío University Hospital, Institute of Biomedicine of Seville (IBiS/CSIC), Seville, Spain
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Epah J, Gülec I, Winter S, Dörr J, Geisen C, Haecker E, Link D, Schwab M, Seifried E, Schäfer R. From Unit to Dose: A Machine Learning Approach for Precise Prediction of Hemoglobin and Iron Content in Individual Packed Red Blood Cell Units. Adv Sci (Weinh) 2022; 9:e2204077. [PMID: 36333123 PMCID: PMC9798979 DOI: 10.1002/advs.202204077] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/24/2022] [Indexed: 06/16/2023]
Abstract
Transfusion of packed red blood cells (pRBCs) saves lives, but iron overload limits survival of chronically transfused patients. Quality control methods, which involve entering pRBC units and removing them from the blood supply, reveal that hemoglobin (38.5-79.9 g) and heme iron (133.42-276.89 mg) vary substantially between pRBCs. Yet, neither hemoglobin nor iron content can be quantified for individual clinically used pRBCs leading to rules of thumb for pRBC transfusions. Keeping their integrity, the authors seek to predict hemoglobin/iron content of any given pRBC unit applying eight machine learning models on 6,058 pRBCs. Based on thirteen features routinely collected during blood donation, production and quality control testing, the model with best trade-off between performance and complexity in hemoglobin/iron content prediction is identified. Validation of this model in an independent cohort of 2637 pRBCs confirms an adjusted R2 > 0.9 corresponding to a mean absolute prediction error of ≤1.43 g hemoglobin/4.96 mg iron (associated standard deviation: ≤1.13 g hemoglobin/3.92 mg iron). Such unprecedented precise prediction enables reliable pRBC dosing per pharmaceutically active agent, and monitoring iron uptake in patients and individual iron loss in donors. The model is implemented in a free open source web application to facilitate clinical application.
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Affiliation(s)
- Jeremy Epah
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Donor Service Baden‐Württemberg‐Hessen gGmbHGoethe University Hospital60528Frankfurt am MainGermany
| | - Ilay Gülec
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Donor Service Baden‐Württemberg‐Hessen gGmbHGoethe University Hospital60528Frankfurt am MainGermany
| | - Stefan Winter
- Dr. Margarete Fischer‐Bosch Institute of Clinical PharmacologyStuttgart, GermanyUniversity of Tübingen72076TübingenGermany
| | - Johanna Dörr
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Donor Service Baden‐Württemberg‐Hessen gGmbHGoethe University Hospital60528Frankfurt am MainGermany
| | - Christof Geisen
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Donor Service Baden‐Württemberg‐Hessen gGmbHGoethe University Hospital60528Frankfurt am MainGermany
| | - Eva Haecker
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Donor Service Baden‐Württemberg‐Hessen gGmbHGoethe University Hospital60528Frankfurt am MainGermany
| | - Dietmar Link
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Donor Service Baden‐Württemberg‐Hessen gGmbHGoethe University Hospital60528Frankfurt am MainGermany
| | - Matthias Schwab
- Dr. Margarete Fischer‐Bosch Institute of Clinical PharmacologyStuttgart, GermanyUniversity of Tübingen72076TübingenGermany
- Departments of Clinical PharmacologyPharmacy and BiochemistryUniversity of Tübingen72076TübingenGermany
- Cluster of Excellence iFIT (EXC 2180), Image‐Guided and Functionally Instructed Tumor Therapies“University of Tübingen72076TübingenGermany
| | - Erhard Seifried
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Donor Service Baden‐Württemberg‐Hessen gGmbHGoethe University Hospital60528Frankfurt am MainGermany
| | - Richard Schäfer
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Donor Service Baden‐Württemberg‐Hessen gGmbHGoethe University Hospital60528Frankfurt am MainGermany
- Institute for Transfusion Medicine and Gene TherapyMedical Center – University of Freiburg79106FreiburgGermany
- Center for Chronic Immunodeficiency (CCI)Medical Center – University of Freiburg79106FreiburgGermany
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21
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Ashwell E. The basics of blood and associated disorders. Br J Nurs 2022; 31:1096-1102. [PMID: 36416634 DOI: 10.12968/bjon.2022.31.21.1096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The blood and its components are involved in a wide range of processes to support life, including fighting infection and providing the body's tissues with oxygen and nutrients. If any stage in the development of blood cells is disrupted, for example by genetic abnormalities or a lack of nutrients, disease may result. This article provides an overview of some of the blood's key components, blood cells and their formation and functions, blood groups and some of the problems that can arise from malfunctions. A case study on haemophilia A as a blood disorder is presented to consolidate knowledge.
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Affiliation(s)
- Emily Ashwell
- Community Case Manager Nurse, Buckinghamshire Healthcare NHS Trust
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22
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Zhang Q, Wang G, Sun D, Lin W, Yan T, Wu Y, Wu M, Chen J, Zou S, Xie W, Zhou Y, Wang Y, He L, Liu Y, Qiu Z, Hu L, Lin B, Zhou X, Li Y, Xu X. MALDI-TOF-MS for Rapid Screening and Typing of β-Globin Variant and β-Thalassemia through Direct Measurements of Intact Globin Chains. Clin Chem 2022; 68:1541-1551. [PMID: 36226750 DOI: 10.1093/clinchem/hvac151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 07/18/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Traditional phenotype-based screening for β-globin variant and β-thalassemia using hematological parameters is time-consuming with low-resolution detection. Development of a MALDI-TOF-MS assay using alternative markers is needed. METHODS We constructed a MALDI-TOF-MS-based approach for identifying various β-globin disorders and classifying thalassemia major (TM) and thalassemia intermedia (TI) patients using 901 training samples with known HBB/HBA genotypes. We then validated the accuracy of population screening and clinical classification in 2 separate cohorts consisting of 16 172 participants and 201 β-thalassemia patients. Traditional methods were used as controls. Genetic tests were considered the gold standard for testing positive specimens. RESULTS We established a prediction model for identifying different forms of β-globin disorders in a single MALDI-TOF-MS test based on δ- to β-globin, γ- to α-globin, γ- to β-globin ratios, and/or the abnormal globin-chain patterns. Our validation study yielded comparable results of clinical specificity (99.89% vs 99.71%), and accuracy (99.78% vs 99.16%) between the new assay and traditional methods but higher clinical sensitivity for the new method (97.52% vs 88.01%). The new assay identified 22 additional abnormal hemoglobins in 69 individuals including 9 novel ones, and accurately screened for 9 carriers of deletional hereditary persistence of fetal hemoglobin or δβ-thalassemia. TM and TI were well classified in 178 samples out of 201 β-thalassemia patients. CONCLUSIONS MALDI-TOF-MS is a highly accurate, predictive tool that could be suitable for large-scale screening and clinical classification of β-globin disorders.
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Affiliation(s)
- Qianqian Zhang
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China.,Innovative Research Center for Diagnosis and Therapy of Thalassemias, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Ge Wang
- Department of Clinical Laboratory, Zhuhai Women and Children's Hospital, Zhuhai, Guangdong, China
| | - Dehui Sun
- Research and Development Center, Intelligene Biosystems (Qingdao) Co., Ltd., Qingdao, Shandong, China
| | - Wanying Lin
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
| | - Tizhen Yan
- Department of Medical Genetics, Liuzhou Key Laboratory of Reproductive Medicine, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, Guangxi, China
| | - Yuanjun Wu
- Department of Transfusion, Dongguan Maternal and Child Health Care Hospital, Dongguan, Guangdong, China
| | - Meiying Wu
- Department of Clinical Laboratory, Huidong Women and Children's Hospital, Huizhou, Guangdong, China
| | - Jianhong Chen
- Department of Medical Genetics and Prenatal Diagnosis, Huizhou First Maternal and Child Health Care Hospital, Huizhou, Guangdong, China
| | - Shaomin Zou
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
| | - Wenchun Xie
- Key Laboratory of Interdisciplinary Research, Institute of Biophysics of Chinese Academy of Sciences, Beijing, China.,Department of Biomedicine, Bioland Laboratory, Guangzhou, Guangdong, China
| | - Yuqiu Zhou
- Department of Clinical Laboratory, Zhuhai Women and Children's Hospital, Zhuhai, Guangdong, China
| | - Yuxi Wang
- Research and Development Center, Intelligene Biosystems (Qingdao) Co., Ltd., Qingdao, Shandong, China
| | - Linlin He
- Center for Marriage and Childbirth, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, Guangxi, China
| | - Yanhui Liu
- Department of Prenatal Diagnosis, Dongguan Institute of Reproductive and Genetic Research, Dongguan Maternal and Child Health Care Hospital, Dongguan, Guangdong, China
| | - Zhenxiong Qiu
- Department of Clinical Laboratory, Huidong Women and Children's Hospital, Huizhou, Guangdong, China
| | - Lingling Hu
- Department of Clinical Laboratory, Zhuhai Women and Children's Hospital, Zhuhai, Guangdong, China
| | - Bin Lin
- Genetics Laboratory, Guangzhou Huayin Healthcare Group Co., Ltd., Guangzhou, Guangdong, China.,Genetics Laboratory, Guangzhou Jiexu Gene Technology Co., Ltd., Guangzhou 510530, Guangdong, China
| | - Xiaoguang Zhou
- Research and Development Center, Intelligene Biosystems (Qingdao) Co., Ltd., Qingdao, Shandong, China
| | - Yan Li
- Key Laboratory of Interdisciplinary Research, Institute of Biophysics of Chinese Academy of Sciences, Beijing, China.,Department of Biomedicine, Bioland Laboratory, Guangzhou, Guangdong, China.,College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
| | - Xiangmin Xu
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China.,Innovative Research Center for Diagnosis and Therapy of Thalassemias, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
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23
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Egesa WI, Nakalema G, Waibi WM, Turyasiima M, Amuje E, Kiconco G, Odoch S, Kumbakulu PK, Abdirashid S, Asiimwe D, Mussa A. Sickle Cell Disease in Children and Adolescents: A Review of the Historical, Clinical, and Public Health Perspective of Sub-Saharan Africa and Beyond. Int J Pediatr 2022; 2022:1-26. [PMID: 36254264 PMCID: PMC9569228 DOI: 10.1155/2022/3885979] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/19/2022] [Indexed: 11/24/2022] Open
Abstract
Sickle cell disease (SCD) is an umbrella term for a group of life-long debilitating autosomal recessive disorders that are caused by a single-point mutation (Glu→Val) that results in polymerization of hemoglobin (Hb) and reversible sickle-shape deformation of erythrocytes. This leads to increased hemolysis of erythrocytes and microvascular occlusion, ischemia-reperfusion injury, and tissue infarction, ultimately causing multisystem end-organ complications. Sickle cell anemia (HbSS) is the most common and most severe genotype of SCD, followed by HbSC, HbSβ0thalassemia, HbSβ+thalassemia, and rare and benign genotypes. Clinical manifestations of SCD occur early in life, are variable, and are modified by several genetic and environmental factors. Nearly 500 children with SCD continue to die prematurely every day, due to delayed diagnosis and/or lack of access to comprehensive care in sub-Saharan Africa (SSA), a trend that needs to be urgently reversed. Despite proven efficacy in developed countries, newborn screening programs are not universal in SSA. This calls for a consolidated effort to make this possible, through the use of rapid, accurate, and cheap point-of-care test kits which require minimal training. For almost two decades, hydroxyurea (hydroxycarbamide), a century-old drug, was the only disease-modifying therapy approved by the U.S. Food and Drug Administration. Recently, the list expanded to L-glutamine, crizanlizumab, and voxelotor, with several promising novel therapies in the pipeline. Despite its several limitations, hematopoietic stem cell transplant (HSCT) remains the only curative intervention for SCD. Meanwhile, recent advances in gene therapy trials offer a glimpse of hope for the near future, although its use maybe limited to developed countries for several decades.
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24
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Guiñón L, Soler A, López RM, Pajares S, de Aledo JMG, Argudo-Ramírez A, Marín JL, García-Villoria J, Sahuquillo Á, Alvarez L. Inter-rater reliability assessment for the new-born screening quality assurance. Biochem Med (Zagreb) 2022; 32:030901. [PMID: 35966259 PMCID: PMC9344869 DOI: 10.11613/bm.2022.030901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/20/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction To ensure the quality of the new-born screening (NBS), our laboratory reviewed the analytical procedure to detect subjective steps that may represent a risk to the patient. Two subjective activities were identified in the extra-analytical phases: the classification of dried blood spots (DBS) according to their quality and the assignment of haemoglobin patterns. To keep these activities under control, inter-rater studies were implemented. This study aimed to evaluate the inter-rater reliability and the effectiveness of the measures taken to improve the agreement between observers, to assure NBS results’ quality. Materials and methods Dried blood spots specimens were used for the inter-rater studies. Ten studies were performed to assess DBS quality classification, and four to assess the assignment of haemoglobin patterns. Krippendorff’s alpha test was used to estimate inter-rater reliability. Causes were investigated when alpha values were below 0.80. Results For both activities, the reliability obtained in the first studies was inadequate. After investigation, we detected that the criterion to classify a DBS as scant was not consolidated, and also a lack of consensus on whether or not to report Bart’s haemoglobin depending on its percentage. Alpha estimates became higher once the training was reinforced and a consensus about the appropriate criteria to be applied was reached. Conclusion Inter-rater reliability assessment helped us to ensure the quality of subjective activities that could add variability to NBS results. Furthermore, the evolution of the alpha value over time allowed us to verify the effectiveness of the measures adopted.
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Affiliation(s)
- Leonor Guiñón
- Quality Department, Biomedical Diagnostic Center, Hospital Clínic of Barcelona, Barcelona, Spain
- Quality Department, Laboratories, Hospital de la Santa Creu i Sant Pau of Barcelona, Barcelona, Spain
- Biochemistry Department, Hospital de la Santa Creu i Sant Pau of Barcelona, Barcelona, Spain
- Corresponding author:
| | - Anna Soler
- Quality Department, Biomedical Diagnostic Center, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Rosa María López
- Division of Inborn Errors of Metabolism, Biochemistry and Molecular Genetics Department, Biomedical Diagnostic Center, Hospital Clínic of Barcelona, IDIBAPS, BarcelonaSpain
| | - Sonia Pajares
- Division of Inborn Errors of Metabolism, Biochemistry and Molecular Genetics Department, Biomedical Diagnostic Center, Hospital Clínic of Barcelona, IDIBAPS, BarcelonaSpain
- Spain Center for Biomedical Research Network on Rare Diseases (CIBERER), Madrid, Spain
| | - José Manuel González de Aledo
- Division of Inborn Errors of Metabolism, Biochemistry and Molecular Genetics Department, Biomedical Diagnostic Center, Hospital Clínic of Barcelona, IDIBAPS, BarcelonaSpain
| | - Ana Argudo-Ramírez
- Division of Inborn Errors of Metabolism, Biochemistry and Molecular Genetics Department, Biomedical Diagnostic Center, Hospital Clínic of Barcelona, IDIBAPS, BarcelonaSpain
| | - José Luis Marín
- Division of Inborn Errors of Metabolism, Biochemistry and Molecular Genetics Department, Biomedical Diagnostic Center, Hospital Clínic of Barcelona, IDIBAPS, BarcelonaSpain
| | - Judit García-Villoria
- Division of Inborn Errors of Metabolism, Biochemistry and Molecular Genetics Department, Biomedical Diagnostic Center, Hospital Clínic of Barcelona, IDIBAPS, BarcelonaSpain
- Spain Center for Biomedical Research Network on Rare Diseases (CIBERER), Madrid, Spain
| | - Ángeles Sahuquillo
- Section of Analytical Chemistry, Faculty of Chemistry, University of Barcelona, Barcelona, Spain
| | - Luisa Alvarez
- Quality Department, Biomedical Diagnostic Center, Hospital Clínic of Barcelona, Barcelona, Spain
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Alashkar F, Aramayo-Singelmann C, Böll J, Hoferer A, Jarisch A, Kamal H, Oevermann L, Schwarz M, Cario H. Transition in Sickle Cell Disease (SCD): A German Consensus Recommendation. J Pers Med 2022; 12:jpm12071156. [PMID: 35887653 PMCID: PMC9325299 DOI: 10.3390/jpm12071156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 06/26/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
Sickle cell disease (SCD) is considered a rare disease in Germany. Due to the increasing prevalence, the acute and chronic morbidities associated with the disease and the sharp increase in the mortality rate of young adults, a need-based transition structure for patients with SCD in Germany is explicitly required. This is the first multicenter German consensus statement addressing the importance of implementing a standardized transition guideline that allows adolescents and young adults to safely transition from pediatric to adult care. Early identification of medical needs and intervention remains important in the context of chronic diseases. Effective measures can improve health care in general, as they lead to a reduction in disease and the consequential economic burden. It is noteworthy that improving structural barriers remains a key challenge even in highly developed countries such as Germany. Inclusion of these transition services for patients with SCD into the regular care of chronically ill adolescents and young adults should be ensured, as well as the coverage of costs associated with a structured transition process.
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Affiliation(s)
- Ferras Alashkar
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
- Correspondence:
| | - Carmen Aramayo-Singelmann
- Department of Pediatrics III, University Children’s Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany;
| | - Janine Böll
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf, University Hospital of Cologne, 50923 Cologne, Germany;
| | - Annette Hoferer
- Hematology/Oncology Department for Adolescent Medicine, Robert-Bosch-Hospital, 70376 Stuttgart, Germany;
| | - Andrea Jarisch
- Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany;
| | - Haytham Kamal
- Joint Practice for Hematology and Oncology, 30625 Hannover, Germany;
| | - Lena Oevermann
- Department of Pediatric Oncology & Hematology, Charité University Medicine, 10117 Berlin, Germany;
| | - Michaela Schwarz
- Department of Hematology, Oncology, and Tumor Immunology, Charité University Medicine, 10117 Berlin, Germany;
| | - Holger Cario
- Department of Pediatrics and Adolescent Medicine & Center for Rare Hematopoietic Disorders and Immunodeficiencies (ZSHI Ulm), Ulm University Medical Center, 89069 Ulm, Germany;
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Dinah C, Greystoke B, Mueller I, Talks J. Action on sickle cell retinopathy: the time is now. Eye (Lond) 2022; 36:1138-9. [PMID: 35087214 DOI: 10.1038/s41433-021-01918-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 11/30/2021] [Accepted: 12/20/2021] [Indexed: 12/26/2022] Open
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Dua M, Bello-Manga H, Carroll YM, Galadanci AA, Ibrahim UA, King AA, Olanrewaju A, Estepp JH. Strategies to increase access to basic sickle cell disease care in low- and middle-income countries. Expert Rev Hematol 2022; 15:333-344. [PMID: 35400264 PMCID: PMC9442799 DOI: 10.1080/17474086.2022.2063116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/04/2022] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Sickle cell disease (SCD) is the most common hemoglobinopathy in the world. Over 90% of those born with SCD live in low- and middle-income countries (LMICs), yet individuals in these settings have much poorer outcomes compared to those in high-income countries. AREAS COVERED This manuscript provides an in-depth review of the cornerstones of basic SCD care, the barriers to implementing these in LMICs, and strategies to increase access in these regions. Publications in English language, peer-reviewed, and edited from 2000 to 2021 were identified on PubMed. Google search was used for gray literature. EXPERT OPINION Outcomes for patients with SCD in high-income countries have improved over the last few decades due to the implementation of universal newborn screening programs and use of routine antimicrobial prophylaxis, increase in therapeutic and curative options, and the adoption of specific measures to decrease risk of stroke. This success has not translated to LMICs due to several reasons including resource constraints. A combination of several strategies is needed to increase access to basic SCD care for patients in these settings.
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Affiliation(s)
- Meghna Dua
- Department of Global Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Halima Bello-Manga
- Department of Hematology and Blood Transfusion, Barau Dikko Teaching Hospital/Kaduna State University, Nigeria
| | - Yvonne M. Carroll
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | | | | | - Allison A. King
- in Occupational Therapy, Departments of Pediatrics, Medicine and Surgery, Washington University School of MedicineProgram , St. Louis, USA
| | - Ayobami Olanrewaju
- Department of Global Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Jeremie H. Estepp
- Department of Global Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
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Archer NM, Inusa B, Makani J, Nkya S, Tshilolo L, Tubman VN, McGann PT, Ambrose EE, Henrich N, Spector J, Ohene-Frempong K. Enablers and barriers to newborn screening for sickle cell disease in Africa: results from a qualitative study involving programmes in six countries. BMJ Open 2022; 12:e057623. [PMID: 35264367 PMCID: PMC8915265 DOI: 10.1136/bmjopen-2021-057623] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES Given the fundamental role of newborn bloodspot screening (NBS) to enable prompt diagnosis and optimal clinical management of individuals with sickle cell disease (SCD), we sought to systematically assess enablers and barriers to implementation of NBS programmes for SCD in Africa using established qualitative research methods. SETTING Childbirth centres and NBS laboratories from six countries in East, West and Southern Africa. PARTICIPANTS Eight programme leaders involved with establishing and operating NBS programmes for SCD in Angola, Democratic Republic of Congo, Ghana, Liberia, Nigeria and Tanzania. PRIMARY AND SECONDARY OUTCOME MEASURES Data obtained through a structured, phased interview approach were analysed using a combination of inductive and deductive codes and used to determine primary themes related to the implementation and sustainability of SCD NBS programmes. RESULTS Four primary themes emerged from the analysis relating to governance (eg, pragmatic considerations when deploying overcommitted clinical staff to perform NBS), technical (eg, design and execution of operational processes), cultural (eg, variability of knowledge and perceptions of community-based staff) and financial (eg, issues that can arise when external funding may effectively preclude government inputs) aspects. Key learnings included perceived factors that contribute to long-term NBS programme sustainability. CONCLUSIONS The establishment of enduring NBS programmes is a proven approach to improving the health of populations with SCD. Organising such programmes in Africa is feasible, but initial implementation does not assure sustainability. Our analysis suggests that future programmes should prioritise government partner participation and funding from the earliest stages of programme development.
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Affiliation(s)
- Natasha M Archer
- Division of Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| | - Baba Inusa
- Evelina London Children's Hospital, London, UK
| | - Julie Makani
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Siana Nkya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Léon Tshilolo
- Institut de Recherche Biomédicale/CEFA and Centre Hospitalier Mère-Enfant Monkole, Kinshasa, Congo
| | - Venee N Tubman
- Texas Children's Cancer and Hematology Centers, Houston, Texas, USA
| | - Patrick T McGann
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Natalie Henrich
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jonathan Spector
- Department of Global Health, Novartis Institutes for Biomedical Research, Cambridge, Massachusetts, USA
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Abadesso C, Pacheco S, Machado MC, Finley GA. Health-Related Quality of Life Assessments by Children and Adolescents with Sickle Cell Disease and Their Parents in Portugal. Children 2022; 9:children9020283. [PMID: 35205003 PMCID: PMC8870385 DOI: 10.3390/children9020283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/06/2022] [Accepted: 02/10/2022] [Indexed: 11/16/2022]
Abstract
Health-Related Quality of Life (HRQL) can be used to measure the impact of Sickle Cell Disease (SCD) on the child and their family and is generally reduced. No research has yet measured HRQL in Portuguese pediatric SCD patients. Objectives: (1) Describe and compare HRQL of children with SCD reported by them and their parents; (2) Compare with a pediatric population with no SCD; (3) Find predictive factors of HRQL in SCD children. Methods: Descriptive, case-control study that included sixty-eight children and adolescents with SCD (aged 3 to 18 years) and their parents. Control group—children with no SCD, matched by age, gender and ethnic background. HRQL was assessed using the multidimensional self-report PedsQL® 4.0 Generic Scales. Summary scores for overall HRQL and subscale scores for physical, emotional, social and school functioning were compared within groups (children-parents) and with the control group. Clinical and socio-demographic variables were analyzed to find predictive factors of HRQL in pediatric SCD patients. Results: Children with SCD and their parents had significantly lower overall and all subdomains of HRQL, compared with the control group. Children with SCD also rated lower when compared with their parents (only significant for social functioning), with low to moderate correlations. Children and parent reports declined with increasing age. Higher pain frequency was associated with worse total and psychosocial domains of HRQL. The number of hospitalizations was a predictor of worse school score, and female gender was a predictor of worse emotional score. Conclusions: SCD significantly affects children’s HRQL. Parents can provide a good proxy report, although both evaluations are beneficial. Disease status, like number of hospitalizations and frequency of pain, influences HRQL. Interventions in SCD should consider improvements in HRQL as an important outcome.
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Affiliation(s)
- Clara Abadesso
- Hospital Prof. Dr. Fernando Fonseca, EPE—Amadora, 2720-276 Amadora, Portugal;
- Correspondence:
| | - Susana Pacheco
- Hospital Prof. Dr. Fernando Fonseca, EPE—Amadora, 2720-276 Amadora, Portugal;
| | - Maria Céu Machado
- Pediatrics, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal;
| | - G. Allen Finley
- Anesthesia & Psychology, Dalhousie University, Halifax, B3H 4R2 NS, Canada;
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Gingell G, Bergemann AD. Disrupting Essentialism in Medical Genetics Education. Med Sci Educ 2022; 32:255-262. [PMID: 35154900 PMCID: PMC8814072 DOI: 10.1007/s40670-021-01458-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 06/14/2023]
Abstract
Many traditional practices in medical genetics education need review to counteract messages of essentialism, or the belief in an underlying natural structure differentiating social categories. While genomics research increasingly disproves a genetic foundation for race, research from educational scholars demonstrates that current medical genetics instruction may actually reinforce racial bias in learners. In this monograph, we outline seven recommendations for medical educators to actively counteract essentialism, racial, and otherwise, in the genetics classroom. In particular, we emphasize the importance of engaging learners in nuanced discussions around stereotyping and its negative consequences for both accurate diagnoses and promoting health equity.
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Affiliation(s)
- Gareth Gingell
- Department of Medical Education, Dell Medical School at The University of Texas at Austin, Austin, TX USA
| | - Andrew D. Bergemann
- Department of Medical Education, Dell Medical School at The University of Texas at Austin, Austin, TX USA
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31
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Huits R, Feyens AM, Lonneville N, Peyrassol X, Adam AS, Gulbis B, Van Esbroeck M. Diagnosis and clinical relevance of co-inheritance of haemoglobin D-Punjab/β+-thalassemia traits in an immigrant Afghan family. J Clin Pathol 2022; 75:861-864. [PMID: 35039448 DOI: 10.1136/jclinpath-2021-208009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/04/2022] [Indexed: 11/03/2022]
Abstract
We report on a Pashtun family affected by haemoglobin D-Punjab/β+-thalassemia to increase the awareness of the increasing prevalence of haemoglobinopathies among primary care physicians. We highlight the diagnostic approach of these conditions and the benefits of genetic counselling.
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Affiliation(s)
- Ralph Huits
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Anne-Marie Feyens
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Niels Lonneville
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Xavier Peyrassol
- Service de Génétique-Centre de Génétique humaine de l'ULB, Universite Libre de Bruxelles, Bruxelles, Belgium
| | - Anne-Sophie Adam
- Department of Clinical Chemistry, Universite Libre de Bruxelles, Bruxelles, Belgium
| | - Beatrice Gulbis
- Department of Clinical Chemistry, Universite Libre de Bruxelles, Bruxelles, Belgium
| | - Marjan Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
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Martella M, Campeggio M, Pulè G, Wonkam A, Menzato F, Munaretto V, Viola G, Da Costa SP, Reggiani G, Araujo A, Cumbà D, Liotta G, Sainati L, Riccardi F, Colombatti R. Distribution of HbS Allele and Haplotypes in a Multi-Ethnic Population of Guinea Bissau, West Africa: Implications for Public Health Screening. Front Pediatr 2022; 10:826262. [PMID: 35463879 PMCID: PMC9021572 DOI: 10.3389/fped.2022.826262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/23/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Sickle Cell Disease (SCD) is an inherited condition that is widespread globally and especially in malaria-endemic West African countries. Limited epidemiological data on SCD are available for Guinea Bissau, where newborn screening is not yet implemented, routine diagnosis is not available, and care is case directed. METHODS Dried blood spots were collected from children accessing two hospitals managed by Italian Non-Governmental Organizations in the capital city of Bissau and sent to Padova for Hemoglobin (Hb) quantification through HPLC and molecular analysis. Beta globin gene analysis was performed in all; and Hb haplotype of the HbSS and HbSA patients was performed in South Africa. One hundred samples belonging to the most frequent ethnic groups were randomly selected for detection of G6PD mutations. RESULTS Samples from 848 consecutive children (498 males and 350 females, mean age 6.8 years) accessing the two hospitals were analyzed: 6.95% AS (4.42% allelic frequency), 0.94% SS, and 0.23% AC. 376G G6PD allelic frequency was 24%; 14.8% in AS individuals. The Senegal haplotype was the most prevalent (31%), and the proposition of chromosomes with the atypical haplotype was surprisingly high (56%). CONCLUSION Our study demonstrates a significant frequency of the HbS allele in the population of Guinea Bissau supporting the implementation of screening strategies. The differences among ethnic groups can help guide targeted interventions for SCD awareness campaigns and determine priority areas for public health interventions. The pilot analysis on haplotypes reveals a large proportion of the atypical haplotype, which may be indicative of a genetically heterogeneous population.
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Affiliation(s)
- Maddalena Martella
- Clinic of Pediatric Hematology Oncology, Department of Woman's and Child's Health, Azienda Ospedale-Università di Padova, Padova, Italy
| | - Mimma Campeggio
- Clinic of Pediatric Hematology Oncology, Department of Woman's and Child's Health, Azienda Ospedale-Università di Padova, Padova, Italy
| | - Gift Pulè
- Division of Human Genetics, University of Cape Town, Cape Town, South Africa
| | - Ambroise Wonkam
- Division of Human Genetics, University of Cape Town, Cape Town, South Africa
| | - Federica Menzato
- Clinic of Pediatric Hematology Oncology, Department of Woman's and Child's Health, Azienda Ospedale-Università di Padova, Padova, Italy
| | - Vania Munaretto
- Clinic of Pediatric Hematology Oncology, Department of Woman's and Child's Health, Azienda Ospedale-Università di Padova, Padova, Italy
| | - Giampietro Viola
- Clinic of Pediatric Hematology Oncology, Department of Woman's and Child's Health, Azienda Ospedale-Università di Padova, Padova, Italy
| | | | - Giulia Reggiani
- Clinic of Pediatric Hematology Oncology, Department of Woman's and Child's Health, Azienda Ospedale-Università di Padova, Padova, Italy
| | | | | | | | - Laura Sainati
- Clinic of Pediatric Hematology Oncology, Department of Woman's and Child's Health, Azienda Ospedale-Università di Padova, Padova, Italy
| | - Fabio Riccardi
- Università di Tor Vergata, Rome, Italy.,Aid, Health and Development Onlus, Rome, Italy
| | - Raffaella Colombatti
- Clinic of Pediatric Hematology Oncology, Department of Woman's and Child's Health, Azienda Ospedale-Università di Padova, Padova, Italy.,Aid, Health and Development Onlus, Rome, Italy
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Suhaimi SA, Zulkipli IN, Ghani H, Abdul-Hamid MRW. Applications of next generation sequencing in the screening and diagnosis of thalassemia: A mini-review. Front Pediatr 2022; 10:1015769. [PMID: 36245713 PMCID: PMC9557073 DOI: 10.3389/fped.2022.1015769] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
Thalassemias are a group of inherited blood disorders that affects 5-7% of the world population. Comprehensive screening strategies are essential for the management and prevention of this disorder. Today, many clinical and research laboratories have widely utilized next-generation sequencing (NGS) technologies to identify diseases, from germline and somatic disorders to infectious diseases. Yet, NGS application in thalassemia is limited and has just recently surfaced due to current demands in seeking alternative DNA screening tools that are more efficient, versatile, and cost-effective. This review aims to understand the several aspects of NGS technology, including its most current and expanding uses, advantages, and limitations, along with the issues and solutions related to its integration into routine screening and diagnosis of thalassemias. Hitherto, NGS has been a groundbreaking technology that offers tremendous improvements as a diagnostic tool for thalassemia in terms of its higher throughput, accuracy, and adaptability. The superiority of NGS in detecting rare variants, solving complex hematological problems, and providing non-invasive alternatives to neonatal diagnosis cannot be overlooked. However, several pitfalls still preclude its use as a stand-alone technique over conventional methods.
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Affiliation(s)
| | | | - Hazim Ghani
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei
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Houwing ME, Muntendam MJ, van Muilekom MM, Teela L, Fijnvandraat K, de Pagter APJ, Heijboer H, van Oers HA, Cnossen MH, Haverman L. Health-related quality of life in infants, toddlers and young children with sickle cell disease. Pediatr Blood Cancer 2022; 69:e29358. [PMID: 34699122 DOI: 10.1002/pbc.29358] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/14/2021] [Accepted: 08/31/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Little is known about health-related quality of life (HRQoL) in young children with sickle cell disease living in a European country. METHODS A retrospective cross-sectional evaluation of TNO-AZL Preschool Children Quality of Life questionnaire (TAPQOL, 0-1 year) and Pediatric Quality of Life Inventory (PedsQL, 2-7 years) data was conducted. Study participants included caregivers of children with sickle cell disease aged 0-7 years attending the sickle cell centre at the Erasmus Medical Center or the Amsterdam University Medical Centers between April 2012 and October 2020. Comparisons were made with normative data on HRQoL in the general paediatric population. RESULTS The study enrolled 136 caregivers of 136 children. In children aged 0-5 years, no significant differences emerged between children with sickle cell disease and the general population. However, in children aged 5-7 years, children with sickle cell disease scored significantly lower on all subscales except for emotional functioning. Multiple regression models showed a negative association between age and HRQoL. No association was found between HRQoL and disease severity or sociodemographic characteristics. CONCLUSIONS This study demonstrates that HRQoL is negatively correlated with age in young children with sickle cell disease with a significantly lower HRQoL in 5- to 7-year-olds when compared to the general population. Our study underlines the importance of measuring HRQoL in young children to identify patients with impaired HRQoL early in life in order to be able to intervene accordingly. Future research should focus on deepening the knowledge of factors influencing HRQoL in children with sickle cell disease.
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Affiliation(s)
- Maite E Houwing
- Department of Paediatric Haematology, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Madieke J Muntendam
- Department of Paediatric Haematology, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Maud M van Muilekom
- Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam University Medical Centers - Emma Children's Hospital, Amsterdam, The Netherlands
| | - Lorynn Teela
- Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam University Medical Centers - Emma Children's Hospital, Amsterdam, The Netherlands
| | - Karin Fijnvandraat
- Department of Paediatric Haematology, Amsterdam University Medical Centers - Emma Children's Hospital, Amsterdam, The Netherlands
| | - Anne P J de Pagter
- Department of Paediatric Haematology, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Henriëtte Heijboer
- Department of Paediatric Haematology, Amsterdam University Medical Centers - Emma Children's Hospital, Amsterdam, The Netherlands
| | - Hedy A van Oers
- Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam University Medical Centers - Emma Children's Hospital, Amsterdam, The Netherlands
| | - Marjon H Cnossen
- Department of Paediatric Haematology, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Lotte Haverman
- Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam University Medical Centers - Emma Children's Hospital, Amsterdam, The Netherlands
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Lobitz S, Kunz J, Cario H, Hakimeh D, Jarisch A, Kulozik AE, Oevermann L, Grosse R. Neugeborenenscreening auf Sichelzellkrankheit in Deutschland. Geburtshilfe Frauenheilkd 2021. [DOI: 10.1055/a-1487-4774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Stephan Lobitz
- Klinik für Pädiatrische Hämatologie und Onkologie, Gemeinschaftsklinikum Mittelrhein, Koblenz, Deutschland
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Montalembert M, Voskaridou E, Oevermann L, Cannas G, Habibi A, Loko G, Joseph L, Colombatti R, Bartolucci P, Brousse V, Galactéros F. Real-Life experience with hydroxyurea in patients with sickle cell disease: Results from the prospective ESCORT-HU cohort study. Am J Hematol 2021; 96:1223-1231. [PMID: 34224583 DOI: 10.1002/ajh.26286] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 12/28/2022]
Abstract
Several controlled studies have evidenced good efficacy and short-term and mid-term safety profiles for hydroxyurea (HU), which has become the cornerstone for prevention of sickle-cell disease (SCD)-related vaso-occlusive crises. However, there are few large-scale reports on its long-term use and certain caregivers and patients have concerns about its safety. Following the licensing of HU in Europe for children and adults with severe forms of SCD, ESCORT-HU was designed as a Phase IV observational cohort study. It included 1906 participants, of whom 55% were adults. The most common hemoglobin (Hb) genotypes were HbSS (84.7%) and HbSβ+ (7.0%). The median duration of follow-up was 45 months, for a total of 7309 patient-years of observation. The dose of HU after 1 year was 20.6 mg/kg/d for children and 16.3 mg/kg/d for adults. There was a statistically significant decrease in the number of vaso-occlusive episodes lasting >48 h, acute chest syndrome episodes, hospitalizations, and the percentage of patients requiring blood transfusions within the first 12 months relative to the year before enrolment. Neutropenia and thrombocytopenia were the most commonly reported adverse effects. No new HU toxicity was identified. Overall, 125 pregnancies were reported in 101 women and no malformations were observed in the neonates. There were 12 pregnancies for partners of male patients treated with HU. One case of fatal myelodysplastic syndrome was reported, for which a causal association with HU could not be excluded. This cohort study of patients with SCD highlights the positive benefit-to-risk ratio of HU in children and adults.
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Affiliation(s)
- Mariane Montalembert
- Reference Centre for Sickle Cell Disease, Department of General Pediatrics and Pediatric Infectious Diseases Necker‐Enfants malades Hospital, Assistance Publique‐Hôpitaux de Paris (AP‐HP) Paris France
| | - Ersi Voskaridou
- Centre of Excellence in Rare Hematological Disease‐Hemoglobinopathies, Laiko General Hospital Athens Greece
| | - Lena Oevermann
- Department of Pediatric Oncology & Hematology Charité University Medicine, Berlin and Berlin Institute of Health Berlin Germany
| | - Giovanna Cannas
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Médecine Interne, Centre de Référence Constitutif: Syndromes Drépanocytaires Majeurs, Thalassémies et Autres Pathologies Rares du Globule Rouge et de l'Erythropoïèse Lyon France
| | - Anoosha Habibi
- Sickle Cell Referral Center, Department of Internal Medicine Henri‐Mondor University Hospital‐UPEC, AP‐HP Créteil France
| | - Gylna Loko
- Centre hospitalier de la Martinique Fort‐de‐France Martinique France
| | - Laure Joseph
- Biotherapy Department Necker Children's Hospital, Assistance Publique‐Hôpitaux de Paris Paris France
| | | | - Pablo Bartolucci
- Sickle Cell Referral Center, Department of Internal Medicine Henri‐Mondor University Hospital‐UPEC, AP‐HP Créteil France
| | - Valentine Brousse
- Reference Centre for Sickle Cell Disease, Department of General Pediatrics and Pediatric Infectious Diseases Necker‐Enfants malades Hospital, Assistance Publique‐Hôpitaux de Paris (AP‐HP) Paris France
| | - Frédéric Galactéros
- Sickle Cell Referral Center, Department of Internal Medicine Henri‐Mondor University Hospital‐UPEC, AP‐HP Créteil France
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Canatan D, Vives Corrons JL, Piacentini G, Kara F, Keskinkılıç B, Tezel B, Külekçi Uğur A, Babayiğit M, Krishnevskaya E, Millimaggi G, Erinekçi O, Özdemir Z, De Sanctis V. Immigration and screening programs for hemoglobinopathies in Italy, Spain and Turkey. Acta Biomed 2021; 92:e2021410. [PMID: 34487057 PMCID: PMC8477095 DOI: 10.23750/abm.v92i4.11965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/04/2021] [Indexed: 11/23/2022]
Abstract
Sickle cell disease (SCD) and thalassemias are the most common monogenic diseases in the world. The number of migrants and refugees in Europe and Turkey, in the past decade, has increased dramatically due to war, violence or prosecutions in their homeland. Prevention and management of haemoglobin disorders is well established and managed in countries where these conditions were traditionally endemic or in countries that have a longstanding tradition of receiving migrants. Therefore, preventive and diagnostic programmes regarding hemoglobinopathies in immigrant populations have been implemented. The purpose of this paper it to report a summary of the experience gained in Italy, Spain and Turkey in migrants, asylum seekers and refugees.
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Affiliation(s)
- Duran Canatan
- Thalassemia Diagnosis Center of Mediterranean Blood Diseases Foundation, Antalya (Turkey).
| | - Joan Lluis Vives Corrons
- Red Blood Cell and Haematopoietic Disorders Unit, Institute for Leukemia Research Josep Carreras (IJC) and University of Barcelona, Catalonia (Spain).
| | | | - Fatih Kara
- General Directory of Public Health of MOH of Turkey, Ankara (Turkey) .
| | - Bekir Keskinkılıç
- General Directory of Public Health of MOH of Turkey, Ankara (Turkey) .
| | - Başak Tezel
- General Directory of Public Health of MOH of Turkey, Ankara (Turkey) .
| | | | - Meliha Babayiğit
- General Directory of Public Health of MOH of Turkey, Ankara (Turkey).
| | - Elena Krishnevskaya
- Red Blood Cell and Haematopoietic Disorders Unit, Institute for Leukemia Research Josep Carreras (IJC) and University of Barcelona, Catalonia (Spain).
| | | | - Ozlem Erinekçi
- Thalassemia Diagnosis Center of Mediterranean Blood Diseases Foundation, Antalya (Turkey).
| | - Zekiye Özdemir
- Thalassemia Diagnosis Center of Mediterranean Blood Diseases Foundation, Antalya (Turkey).
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Dexter D, McGann PT. The promise and role of point of care testing to reduce the global burden of sickle cell disease through early diagnosis and linkage to care. Br J Haematol 2021; 196:63-69. [PMID: 34340260 DOI: 10.1111/bjh.17678] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/12/2021] [Indexed: 11/28/2022]
Abstract
Sickle cell disease (SCD) is a devastating and under-recognised global child health issue affecting over 300,000 infants annually, with the highest prevalence in India and sub-Saharan Africa. Most affected infants born in low- and middle-income countries (LMIC) lack access to SCD testing and die from complications in the first years of life without a formal diagnosis. The majority of deaths are preventable with early diagnosis and provision of inexpensive interventions. Despite global recognition of the urgent need, expansion of SCD newborn screening (NBS) programmes beyond the pilot stage has been obstructed by a dependence on an expensive and logistically challenging centralised laboratory testing model. Recently, several point-of-care tests (POCT) for SCD have been developed with promising field validation studies. Here, we summarise the state of POCT for SCD, review barriers and unanswered questions, and discuss optimal strategies for utilising POCT to address the growing global burden of SCD. There is an urgent need to prospectively evaluate the ability of POCT to reduce the morbidity and high early mortality of SCD. To impact a sustainable reduction to this end, it is essential to link a diagnosis with comprehensive SCD care, including wide and affordable access to affordable hydroxycarbamide therapy.
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Affiliation(s)
- Daniel Dexter
- Department of Paediatrics, St Mary's Hospital, Imperial College Healthcare Trust, London, UK
| | - Patrick T McGann
- Division of Hematology and Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Achour A, Koopmann TT, Baas F, Harteveld CL. The Evolving Role of Next-Generation Sequencing in Screening and Diagnosis of Hemoglobinopathies. Front Physiol 2021; 12:686689. [PMID: 34385932 PMCID: PMC8353275 DOI: 10.3389/fphys.2021.686689] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/11/2021] [Indexed: 11/23/2022] Open
Abstract
During the last few years, next-generation sequencing (NGS) has undergone a rapid transition from a research setting to a clinical application, becoming the method of choice in many clinical genetics laboratories for the detection of disease-causing variants in a variety of genetic diseases involving multiple genes. The hemoglobinopathies are the most frequently found Mendelian inherited monogenic disease worldwide and are composed of a complex group of disorders frequently involving the inheritance of more than one abnormal gene. This review aims to present the role of NGS in both screening and pre- and post-natal diagnostics of the hemoglobinopathies, and the added value of NGS is discussed based on the results described in the literature. Overall, NGS has an added value in large-scale high throughput carrier screening and in the complex cases for which common molecular techniques have some inadequacies. It is proven that the majority of thalassemia cases and Hb variants can be diagnosed using routine analysis involving a combined approach of hematology, hemoglobin separation, and classical DNA methods; however, we conclude that NGS can be a useful addition to the existing methods in the diagnosis of these disorders.
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Affiliation(s)
- Ahlem Achour
- Department of Clinical Genetics/LDGA, Leiden University Medical Center, Leiden, Netherlands.,Department of Congenital and Hereditary Diseases, Charles Nicolle Hospital, Tunis, Tunisia
| | - Tamara T Koopmann
- Department of Clinical Genetics/LDGA, Leiden University Medical Center, Leiden, Netherlands
| | - Frank Baas
- Department of Clinical Genetics/LDGA, Leiden University Medical Center, Leiden, Netherlands
| | - Cornelis L Harteveld
- Department of Clinical Genetics/LDGA, Leiden University Medical Center, Leiden, Netherlands
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40
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Felli E, Felli E, Muttillo EM, Memeo R, Giannelli V, Colasanti M, Pellicelli A, Diana M, Ettorre GM. Liver transplantation for sickle cell disease: a systematic review. HPB (Oxford) 2021; 23:994-999. [PMID: 33431265 DOI: 10.1016/j.hpb.2020.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/03/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Sickle cell disease is a group of autosomal recessive disorders characterised by haemolytic anaemia. Liver is one of the most affected organs, ranging from liver tests alterations to acute liver failure for which liver transplantation is the only life-saving treatment. METHODS This study aims to make a systematic review of the current literature to evaluate indications, timing, and results of liver transplantation for patients affected by SCD. RESULTS Twenty-nine patients in total were reported worldwide until 2018, the average patient age is 28.7 (0.42-56), all patients have a pre-transplant diagnosis of SCD. Cirrhosis at transplantation was present in six-teen (n = 16, 55.1%) patients. In ten patients (n = 10, 34.5%), acute liver failure arises from healthy liver and presented sickle cell intrahepatic cholestasis. Eleven patients (n = 11, 39.2%) died, three (n = 3, 10.7%) in the first postoperative month, and seven (n = 7, 25%) in the first year. Mean follow-up was 27 months (range: 7-96), one-year overall survival was 48.7%. DISCUSSION Liver transplantation for SCD has been increasingly reported with encouraging results. Indications are presently reserved for acute liver failure arising both in healthy liver and end-stage liver disease.
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Affiliation(s)
- Emanuele Felli
- Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France; IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France; Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France; Institute of Viral and Liver Disease, Inserm U1110, Strasbourg, France.
| | - Eric Felli
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France; Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
| | - Edoardo M Muttillo
- Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France; Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Riccardo Memeo
- Division of Hepato-Pancreato-Biliary Surgery, "F. Miulli" General Hospital, Acquaviva Delle Fonti, Bari, Italy; Liver Transplant Unit, Policlinico di Bari, Bari, Italy
| | - Valerio Giannelli
- San Camillo Hospital, Department of Transplantation and General Surgery, Rome, Italy
| | - Marco Colasanti
- San Camillo Hospital, Department of Transplantation and General Surgery, Rome, Italy
| | - Adriano Pellicelli
- San Camillo Hospital, Department of Transplantation and General Surgery, Rome, Italy
| | - Michele Diana
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France; Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France; ICUBE Laboratory, Photonics Instrumentation for Health, University of Strasbourg, Strasbourg, France
| | - Giuseppe M Ettorre
- San Camillo Hospital, Department of Transplantation and General Surgery, Rome, Italy
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Tegha G, Topazian HM, Kamthunzi P, Howard T, Tembo Z, Mvalo T, Chome N, Kumwenda W, Mkochi T, Hernandez A, Ataga KI, Hoffman IF, Ware RE. Prospective Newborn Screening for Sickle Cell Disease and Other Inherited Blood Disorders in Central Malawi. Int J Public Health 2021; 66:629338. [PMID: 34335138 PMCID: PMC8284589 DOI: 10.3389/ijph.2021.629338] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 06/11/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Newborn screening in the United States and Europe allows early identification of congenital disorders but does not yet exist in most low-resource settings, especially in sub-Saharan Africa. Newborn screening can identify multiple inherited hematological disorders, but feasibility and effectiveness for Africa are not fully determined. Methods: Surplus dried blood spot collected in Central Malawi through the HIV Early Infant Diagnosis surveillance program were repurposed and tested by isoelectric focusing for sickle cell disease and trait. Additional genetic testing identified G6PD deficiency and alpha thalassemia. Results: Testing of 10,529 cards revealed an overall sickle cell trait prevalence of 7.0% (range 3.9-9.7% by district); 10 of 14 infants identified with sickle cell disease (prevalence 0.1%) were located and received care at a specialized clinic. Subsequent testing of 1,329 randomly selected cards identified alpha thalassemia trait in 45.7% of samples, and G6PD deficiency in 20.4% of males and 3.4% of females, with 29.0% of females as heterozygous carriers. Conclusion: Inherited hematological disorders are common in Central Malawi; early identification through newborn screening can improve clinical outcomes and should be supported throughout Africa.
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Affiliation(s)
- Gerald Tegha
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Hillary M. Topazian
- University of North Carolina Project-Malawi, Lilongwe, Malawi
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, United States
| | - Portia Kamthunzi
- University of North Carolina Project-Malawi, Lilongwe, Malawi
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, United States
| | - Thad Howard
- Division of Hematology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Zondwayo Tembo
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Tisungane Mvalo
- University of North Carolina Project-Malawi, Lilongwe, Malawi
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC, United States
| | - Nelecy Chome
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Wiza Kumwenda
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Tawonga Mkochi
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Arielle Hernandez
- Division of Hematology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Kenneth I. Ataga
- Center for Sickle Cell Disease, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Irving F. Hoffman
- University of North Carolina Project-Malawi, Lilongwe, Malawi
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, United States
| | - Russell E. Ware
- Division of Hematology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Global Health Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
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Lobitz S, Kunz JB, Cario H, Hakimeh D, Jarisch A, Kulozik AE, Oevermann L, Grosse R. Neugeborenenscreening auf Sichelzellkrankheit. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-021-01213-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Newborn screening (NBS) for sickle cell disease (SCD) in France has allowed the identification of 9,260 children with SCD since 1989, including 583 in 2019. In mainland France, however, SCD screening is targeted to newborns identified at risk of SCD, i.e born from parents originating from countries with a high SCD prevalence. This screening program, combined to prophylactic measures and a well-organized social and health network in France, has demonstrated considerable efficacy in reducing childhood mortality as well as severe infectious, anemic and neurovascular complications in childhood. SCD NBS has additionally allowed the identification of 180,687 heterozygous (AS) children since 1989. The increasing incidence of SCD (1/1,303 new-borns identified in 2019 versus 1/2,089 in 2009) now pleads for universal NBS and strong advocacy regarding SCD, the most frequent disease identified by NBS in France, and a major public health issue.
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Affiliation(s)
- Valentine Brousse
- Centre de référence de la drépanocytose, Hôpital universitaire Robert Debré, 48 boulevard Sérurier, AP-HP, 75019 Paris, France - Inserm UMRS1134 - Biologie intégrée du globule rouge, 6 rue Alexandre-Cabanel, 75015 Paris, France
| | - Bichr Allaf
- Service de biochimie, Hôpital universitaire Robert Debré, 48 boulevard Sérurier, AP-HP, 75019 Paris, France
| | - Malika Benkerrou
- Centre de référence de la drépanocytose, Hôpital universitaire Robert Debré, 48 boulevard Sérurier, AP-HP, 75019 Paris, France - Inserm UMR 1123-Épidémiologie clinique, évaluation économique appliquées aux populations vulnérables (ECEVE), 10 avenue de Verdun, 75010 Paris, France
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Alp G, Oztas Y. Facile L-Glutamine delivery to erythrocytes via DOPC-DPPG mixed liposomes. J Liposome Res 2021; 31:409-419. [PMID: 33944651 DOI: 10.1080/08982104.2021.1918152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Sickle cell disease (SCD) is a mortal erythrocyte-based disease which is hard to treat effectively. Development of a treatment method that can prevent deoxygenation of erythrocytes or reduce the oxidative stress of sickle erythrocytes is one of the important issues towards SCD. Among a wide variety of potential drug carriers, liposomes are advantageous and preferable with their easy preparation and biocompatibility. In this study, L-Glutamine (Gln) loaded liposomes were prepared with 1,2-Dioleoyl-sn-glycero-3-phosphocholine (DOPC) and 1,2-Dioleoyl-sn-glycero-3-phospho-rac-(1-glycerol) sodium salt (DPPG). Liposomes were characterized via zeta potential, size measurements, differential scanning calorimetry, Fourier Transform Infra-red Spectroscopy and they were visualized via transmission electron microscopy and scanning electron microscopy. Effect of the encapsulated amount of Gln was investigated by encapsulating Gln at three different concentrations (i.e0.20 mM, 40 mM and 60 mM). Drug encapsulation and release studies were implemented with high pressure liquid chromatography (HPLC). The encapsulation efficiency of Gln was determined to be the higher than the ones reported in the literature: 83.6%, 87.1% and 84.9% for 20 mM, 40 mM and 60 mM Gln, respectively. It was found that after 6 hours, liposomes loaded with 60 mM of Gln had released 45.7% of Gln. Optical microscopy images of the erythrocytes after 3 hours of incubation and haemolysis measurements proved that presence of liposomes did not cause any structural changes on the erythrocyte shape. Overall, it was concluded that L-Gln loaded PC/PG liposomes provide promising results in terms of developing a new drug delivery platform for SCD.
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Affiliation(s)
- Gokce Alp
- Department of Chemical Engineering, Faculty of Engineering, Hacettepe University, Ankara, Turkey
| | - Yesim Oztas
- Department of Medical Biochemistry, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Affiliation(s)
- Rute B Baptista
- Department of Paediatrics, Hospital de Dona Estafânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.,Pathophysiology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Edgar Almeida
- Pathophysiology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.,Department of Nephrology, Hospital Beatriz Ângelo, Loures, Portugal
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Parodi E, Voi V, Vania B, Lonardi P, Saracco P, Longobardo A, Grassitelli S, Peruzzi L, Scolfaro C, Piga A. Simultaneous diagnosis of severe SARS-CoV-2 infection and sickle cell disease in two infants. Blood Transfus 2021; 19:120-3. [PMID: 33539288 DOI: 10.2450/2021.0430-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/11/2020] [Indexed: 02/04/2023]
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Lobitz S, Kunz JB, Cario H, Hakimeh D, Jarisch A, Kulozik AE, Oevermann L, Grosse R. Introduction of Universal Newborn Screening for Sickle Cell Disease in Germany-A Brief Narrative Review. Int J Neonatal Screen 2021; 7. [PMID: 33525323 DOI: 10.3390/ijns7010007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 11/17/2022] Open
Abstract
Sickle cell disease (SCD) is a severe non-malignant disorder of hemoglobin and is inherited in an autosomal-recessive manner [...].
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Adegoke SA, Oladimeji OI, Akinlosotu MA, Akinwumi AI, Matthew KA. HemoTypeSC point-of-care testing shows high sensitivity with alkaline cellulose acetate hemoglobin electrophoresis for screening hemoglobin SS and SC genotypes. Hematol Transfus Cell Ther 2021; 44:341-345. [PMID: 33531281 PMCID: PMC9477771 DOI: 10.1016/j.htct.2020.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/12/2020] [Accepted: 11/03/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction By providing timely actionable results for prompt management, point-of-care testing (POCT) kits have revolutionised medical care for various diseases, ranging from infectious diseases like malaria to genetic disorders, such as sickle cell disease (SCD). They are, however, underutilised in the diagnosis of SCD in developing countries, where the need is greatest. Objective The study was aimed at assessing the sensitivity of HemoTypeSC POCT among a cohort of children with SCD, previously diagnosed by Alkaline cellulose acetate hemoglobin electrophoresis (ACAE), with or without high-performance liquid chromatography (HPLC). Methods In this descriptive cross-sectional study, HemoTypeSC test was conducted on all participants and its sensitivity was determined by comparing results with those obtained using ACAE. Discordance was verified with HPLC. Results One hundred and forty-five children aged one to 19 years were studied. There were 84 males and 61 females (male: female ratio = 1.4: 1). The HemoTypeSC was able to correctly diagnose sickle cell anemia (SCA) and hemoglobin SC in all (100%) of the children tested. Conclusion The HemoTypeSC shows high sensitivity in detecting SCA and hemoglobin SC. Hence, it is useful for targeted screening of individuals suspected of having SCD, leading to rapid diagnosis of these hemoglobinopathies, even in resource-constrained settings.
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Iwasaki T, Nara S, Nishimura Y, Ueda H, Kishi Y, Esaki M, Shimada K, Hiraoka N. Postoperative acute multiple organ failure after hepatectomy in a Nigerian male with sickle cell trait: a case report. Surg Case Rep 2021; 7:19. [PMID: 33438090 PMCID: PMC7803851 DOI: 10.1186/s40792-020-01102-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 12/26/2020] [Indexed: 11/21/2022] Open
Abstract
Background Sickle cell disease (SCD) is a monogenic disease characterized by sickle hemoglobin (HbS). Patients homozygous for HbS experience symptoms resulting from sickled erythrocytes no later than adolescence. However, heterozygous HbS carriers, or those with the so-called sickle cell trait (SCT), may undergo surgery without their hemoglobinopathy being known. Case presentation A 53-year-old Nigerian male with hepatitis C infection underwent radiofrequency ablation therapy for multiple hepatocellular carcinomas (HCCs) 17 months prior. Follow-up computed tomography (CT) revealed a solitary tumor (3.2 cm) in the medial section of the cirrhotic liver. The Child–Pugh score was five, and the indocyanine green retention rate at 15 min was 17.4%. The nontumorous liver of the medial section accounted for 10% of the total liver volume according to CT volumetry. With the diagnosis of recurrent HCC, left medial sectionectomy was performed under intermittent blood flow occlusion by Pringle’s maneuver. Intraoperative ultrasonography confirmed that hepatic blood flow had been preserved after hepatectomy. However, laboratory tests on postoperative day (POD) 1 revealed severe liver damage: aspartate aminotransferase 9250 IU/L, alanine aminotransferase 6120 IU/L, total bilirubin 2.8 mg/dL, and prothrombin time% 20.9%. The patient’s renal and respiratory functions also deteriorated; therefore, continuous hemodiafiltration and plasma exchange were initiated under mechanical ventilation. Whole-body contrast-enhanced CT showed no apparent ischemia of the remnant liver, but diffuse cerebral infarction was detected. Despite intensive treatments, he died of multiple organ failure on POD 20. The pathological examination of the resected specimen revealed that the intrahepatic peripheral vessels were occluded by sickled erythrocytes. Additionally, chromatographic analysis of hemoglobin detected the presence of abnormal hemoglobin, although microscopic examination of the peripheral blood erythrocytes did not show morphological abnormalities. Based on these findings, we determined that he had SCT and developed vaso-occlusive crisis involving multiple organs just after hepatectomy. Conclusion SCD is a rare disease in eastern Asia, but its prevalence is increasing globally. Surgeons should pay increased attention to this disease, especially when performing hepatectomy under blood flow occlusion.
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Affiliation(s)
- Toshimitsu Iwasaki
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Satoshi Nara
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Yuuki Nishimura
- Division of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroki Ueda
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yoji Kishi
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Minoru Esaki
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Kazuaki Shimada
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Nobuyoshi Hiraoka
- Division of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan
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Santos HPD, Domingos CRB, Castro SMD. Twenty Years of Neonatal Screening for Sickle Cell Disease in Brazil: The Challenges of a Continental Country with High Genetic Heterogeneity. J inborn errors metab screen 2021. [DOI: 10.1590/2326-4594-jiems-2021-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | - Simone Martins de Castro
- Universidade Federal do Rio Grande do Sul, Brasil; Hospital Materno Infantil Presidente Vargas, Brasil
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