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Italia K, Upadhye D, Dabke P, Kangane H, Colaco S, Sawant P, Nadkarni A, Gorakshakar A, Jain D, Italia Y, Ghosh K, Colah R. Clinical and hematological presentation among Indian patients with common hemoglobin variants. Clin Chim Acta 2014; 431:46-51. [PMID: 24508621 DOI: 10.1016/j.cca.2014.01.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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: 11/01/2013] [Revised: 01/21/2014] [Accepted: 01/22/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Co-inheritance of structural hemoglobin variants like HbS, HbD(Punjab) and HbE can lead to a variable clinical presentation and only few cases have been described so far in the Indian population. METHODS We present the varied clinical and hematological presentation of 22 cases (HbSD(Punjab) disease-15, HbSE disease-4, HbD(Punjab)E disease-3) referred to us for diagnosis. RESULTS Two of the 15 HbSD(Punjab) disease patients had moderate crisis, one presented with mild hemolytic anemia; however, the other 12 patients had a severe clinical presentation with frequent blood transfusion requirements, vaso occlusive crisis, avascular necrosis of the femur and febrile illness. The 4 HbSE disease patients had a mild to moderate presentation. Two of the 3 HbD(Punjab)E patients were asymptomatic with one patient's sibling having a mild presentation. The hemoglobin levels of the HbSD(Punjab) disease patients ranged from 2.3 to 8.5 g/dl and MCV from 76.3 to 111.6 fl. The hemoglobin levels of the HbD(Punjab)E and HbSE patients ranged from 10.8 to 11.9 and 9.8 to 10.0 g/dl whereas MCV ranged from 67.1 to 78.2 and 74.5 to 76.0 fl respectively. CONCLUSIONS HbSD(Punjab) disease patients should be identified during newborn screening programmes and managed in a way similar to sickle cell disease. Couple at risk of having HbSD(Punjab) disease children may be given the option of prenatal diagnosis in subsequent pregnancies.
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Affiliation(s)
- Khushnooma Italia
- National Institute of Immunohaematology, 13th Floor, K.E.M. Hospital Campus, Parel, Mumbai 400 012, India
| | - Dipti Upadhye
- National Institute of Immunohaematology, 13th Floor, K.E.M. Hospital Campus, Parel, Mumbai 400 012, India
| | - Pooja Dabke
- National Institute of Immunohaematology, 13th Floor, K.E.M. Hospital Campus, Parel, Mumbai 400 012, India
| | - Harshada Kangane
- National Institute of Immunohaematology, 13th Floor, K.E.M. Hospital Campus, Parel, Mumbai 400 012, India
| | - Stacy Colaco
- National Institute of Immunohaematology, 13th Floor, K.E.M. Hospital Campus, Parel, Mumbai 400 012, India
| | - Pratibha Sawant
- National Institute of Immunohaematology, 13th Floor, K.E.M. Hospital Campus, Parel, Mumbai 400 012, India
| | - Anita Nadkarni
- National Institute of Immunohaematology, 13th Floor, K.E.M. Hospital Campus, Parel, Mumbai 400 012, India
| | - Ajit Gorakshakar
- National Institute of Immunohaematology, 13th Floor, K.E.M. Hospital Campus, Parel, Mumbai 400 012, India
| | - Dipty Jain
- Department of Paediatrics, Government Medical College, Nagpur, India
| | | | - Kanjaksha Ghosh
- National Institute of Immunohaematology, 13th Floor, K.E.M. Hospital Campus, Parel, Mumbai 400 012, India
| | - Roshan Colah
- National Institute of Immunohaematology, 13th Floor, K.E.M. Hospital Campus, Parel, Mumbai 400 012, India.
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