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Rogers K, Alsawas M, Chapman J, Schlueter AJ, Knudson CM. Using the daily rate of rise in hemoglobin S to manage RBC depletion/exchange treatment in sickle cell disease. Transfusion 2024; 64:685-692. [PMID: 38506484 DOI: 10.1111/trf.17797] [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: 01/29/2024] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Red blood cell exchange is often used prophylactically in patients with sickle cell disease, with the goal to maintain hemoglobin S (HbS) below a target threshold level. We reviewed whether the daily "rate of rise" (RoR) in HbS that occurs between procedures can be used for patient management. For some patients not achieving their HbS goals despite efficient exchanges, the post-procedure hematocrit (Hct) target is increased to potentially suppress HbS production. This case series explores the utility of this approach, other clinical uses of the daily RoR in HbS, and the factors that influence it. STUDY DESIGN AND METHODS A total of 660 procedures from 24 patients undergoing prophylactic RBC depletion/exchange procedures were included. Laboratory values and clinical parameters were collected and used to calculate the daily RoR in HbS. Factors such as Hct or medications that might influence the RoR in HbS were evaluated. RESULTS The RoR in HbS varied widely between patients but remained relatively stable within individuals. Surprisingly, this value was not significantly influenced by changes in post-procedure Hct or concurrent hydroxyurea use. A patient's average RoR in HbS effectively predicted the pre-procedure HbS at the following visit (R2 = 0.65). DISCUSSION The RoR in HbS is a relatively consistent parameter for individual patients that is unaffected by medication use or procedural Hct targets and may be useful in determining intervals between procedures.
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Affiliation(s)
- Kai Rogers
- Department of Pathology, University of Iowa Health Care, Iowa City, Iowa, USA
| | - Mouaz Alsawas
- Department of Pathology, University of Iowa Health Care, Iowa City, Iowa, USA
| | - James Chapman
- Department of Pathology, University of Iowa Health Care, Iowa City, Iowa, USA
| | - Annette J Schlueter
- Department of Pathology, University of Iowa Health Care, Iowa City, Iowa, USA
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Elhamrawy A, Veneziano G, Tobias JD. Regional anesthesia and sickle cell crisis in pediatric patients: An educational-focused review. Paediatr Anaesth 2024; 34:195-203. [PMID: 37983941 DOI: 10.1111/pan.14801] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Sickle cell disease (SCD) is the most common inherited hemoglobinopathy, affecting approximately 100 000 patients in United States and millions worldwide. Although the mainstay of pain management for VOC remains systemic opioids, given the potential for adverse effects including respiratory depression and hypoxemia, there remains interest in the use of regional anesthetic techniques (neuraxial or peripheral nerve blockade). METHODS A systematic search of pubMed, Scopus, and Google Scholar was conducted using the terms sickle cell disease, sickle cell crisis, pain crisis, vaso-occlusive crisis, regional anesthesia, peripheral nerve blockade, and neuraxial anesthesia. RESULTS We identified 7 publications, all of which were retrospective case series or single case reports, outlining the use of neuraxial anesthesia in a total of 26 patients with SCD. Additionally, we identified 4 publications, including one retrospective case series and 3 single case reports, entailing the use of peripheral blockade in patients with VOC and SCD. DISCUSSION The available literature, albeit all retrospective or anecdotal, suggests the potential utility of regional anesthesia to treat pain in patients with SCD. Additional benefits have included avoidance of the potential deleterious physiologic effects of systemic opioids and in one case series, an improvement in respiratory function as judged by pulse oximetry. The anecdotal and retrospective nature of the available reports with an absence of prospective trials limits the evidence based medicine available from which to develop to guidlines for the optimal local anesthetic agent to use, its concentration, the rate of infusion, and the choice of adjunctive agents.
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Affiliation(s)
- Amr Elhamrawy
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Giorgio Veneziano
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Garozzo G, Messina R, Manca P, Aquilina A. Transfusion in hemoglobinopathies and red blood cell alloimmunization: data from Sicily, Sardinia and Malta. Blood Transfus 2024; 22:111-121. [PMID: 37235738 PMCID: PMC10920071 DOI: 10.2450/bloodtransfus.465] [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] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/12/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Hemoglobinopathies are a group of diseases that include those due to globin gene mutations, such as thalassemia major (TM) and thalassemia intermedia (TI) or due to alteration of hemoglobin structure such as sickle cell disease (SCD), as well as a combination of these conditions such as thalasso-drepanocytosis (TD). They constitute the most frequent hereditary anemias requiring blood transfusion. MATERIALS AND METHODS In April 2022, a questionnaire was sent to the Transfusion Services (TS) of Sicily, Sardinia and the Maltese National Blood Transfusion (MNBT) service. The questionnaire was divided into a generic part including the number of patients followed and the type of hemoglobinopathy, and a section relating to transfusion therapy, including the number of units transfused, whether red blood cells (RBC) were washed and, finally, a section relating to the presence or absence of alloantibodies and their identification. RESULTS Data was retrieved for 2,574 patients: 68.6% TM, 15.4% TI, 10.3% TD, 4.1% SCD, and 1.6% other hemoglobinopathies (OHA). The number of RBC units transfused was 76,974, equivalent to 24.5% of all the RBCU transfused from the total number of patients followed. The number of washed RBCU was 21.1% of all the units used; 337 patients (37%) were diagnosed with alloantibodies, the majority of which were patients with SCD (20.6%). Of the 485 alloantibodies found, 90.3% were identified. The antibodies found most frequently were related to the Kell system (41.7%) followed by antibodies to the Rhesus system (37.9%); 29.7% of patients had more than one antibody. DISCUSSION From our study, certain indications can be formulated: complete the National Registry for patients with hemoglobinopathies; create a Registry of alloimmunized patients to ensure transfusion therapy is as safe as possible, considering antibody evanescence; and 3) increase the recruitment of blood donors of diverse ethnicities.
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Affiliation(s)
- Giovanni Garozzo
- Italian Society of Transfusion Medicine and Immunohematology (SIMTI), Regional Section of Sicily, St. Luke’s Hospital, Guardamangia, Malta
| | - Renato Messina
- Italian Society of Transfusion Medicine and Immunohematology (SIMTI), Regional Section of Sicily, St. Luke’s Hospital, Guardamangia, Malta
| | - Pietro Manca
- Italian Society of Transfusion Medicine and Immunohematology (SIMTI), Regional Section of Sardinia, St. Luke’s Hospital, Guardamangia, Malta
| | - Alex Aquilina
- Maltese National Blood Transfusion Service, St. Luke’s Hospital, Guardamangia, Malta
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Mekelenkamp H, de Vries M, Saalmink I, Nur E, Kerkhoffs JL, Heijboer H, Cnossen M, Lankester A, Smiers F. Hoping for a normal life: Decision-making on hematopoietic stem cell transplantation by patients with a hemoglobinopathy and their caregivers. Pediatr Blood Cancer 2024; 71:e30808. [PMID: 38082534 DOI: 10.1002/pbc.30808] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/10/2023] [Accepted: 11/27/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND To provide insight into the perspectives of children and young adults with transfusion-dependent thalassemia and sickle cell disease and their caregivers regarding the decision for hematopoietic stem cell transplantation (HSCT). PROCEDURE A qualitative longitudinal multicenter study. Data collection consisted of 40 audio-recorded conversations between physicians and families and 77 interviews with patients and/or caregivers related to 27 unique cases, collected at different time points throughout the decision-making process. RESULTS Conversations and interviews revealed "hoping for a normal life" as an overarching theme, consisting of four main topics: (i) "Building a frame of reference" refers to a process where patients or families try to obtain comprehensive information on HSCT and translate this to their situation to decide. (ii) "Balancing between loss and benefit" reports the process of considering the advantages and disadvantages of continuing with supportive care to treat their disease versus choosing HSCT. (iii) "Experiencing the impact of HSCT" describes the impactfull experience of the HSCT period by those who chose HSCT. (iv) "Balancing again" refers to reflecting on the decision made. CONCLUSIONS The hope for a normal life guided the decision-making process, described as a constant balance between the impact of the disease and HSCT. A structured approach to explore patients' and caregivers' perspectives on HSCT decision-making is needed, where specifically discussing the impact of the disease and hope for a normal life need to be integrated in the process.
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Affiliation(s)
- Hilda Mekelenkamp
- Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Medical Ethics and Health Law, Leiden University Medical Centre, Leiden, The Netherlands
| | - Martine de Vries
- Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Medical Ethics and Health Law, Leiden University Medical Centre, Leiden, The Netherlands
| | - Ineke Saalmink
- Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
| | - Erfan Nur
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Blood Cell Research, Sanquin Research, Amsterdam, The Netherlands
| | | | - Harriët Heijboer
- Department of Pediatric Hematology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Marjon Cnossen
- Department of Pediatric Hematology and Oncology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Arjan Lankester
- Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
| | - Frans Smiers
- Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
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Kashyap Y, Wang ZJ. Gut microbiota dysbiosis alters chronic pain behaviors in a humanized transgenic mouse model of sickle cell disease. Pain 2024; 165:423-439. [PMID: 37733476 PMCID: PMC10843763 DOI: 10.1097/j.pain.0000000000003034] [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: 05/02/2023] [Accepted: 05/31/2023] [Indexed: 09/23/2023]
Abstract
ABSTRACT Pain is the most common symptom experienced by patients with sickle cell disease (SCD) throughout their lives and is the main cause of hospitalization. Despite the progress that has been made towards understanding the disease pathophysiology, major gaps remain in the knowledge of SCD pain, the transition to chronic pain, and effective pain management. Recent evidence has demonstrated a vital role of gut microbiota in pathophysiological features of SCD. However, the role of gut microbiota in SCD pain is yet to be explored. We sought to evaluate the compositional differences in the gut microbiota of transgenic mice with SCD and nonsickle control mice and investigate the role of gut microbiota in SCD pain by using antibiotic-mediated gut microbiota depletion and fecal material transplantation (FMT). The antibiotic-mediated gut microbiota depletion did not affect evoked pain but significantly attenuated ongoing spontaneous pain in mice with SCD. Fecal material transplantation from mice with SCD to wild-type mice resulted in tactile allodynia (0.95 ± 0.17 g vs 0.08 ± 0.02 g, von Frey test, P < 0.001), heat hyperalgesia (15.10 ± 0.79 seconds vs 8.68 ± 1.17 seconds, radiant heat, P < 0.01), cold allodynia (2.75 ± 0.26 seconds vs 1.68 ± 0.08 seconds, dry ice test, P < 0.01), and anxiety-like behaviors (Elevated Plus Maze Test, Open Field Test). On the contrary, reshaping gut microbiota of mice with SCD with FMT from WT mice resulted in reduced tactile allodynia (0.05 ± 0.01 g vs 0.25 ± 0.03 g, P < 0.001), heat hyperalgesia (5.89 ± 0.67 seconds vs 12.25 ± 0.76 seconds, P < 0.001), and anxiety-like behaviors. These findings provide insights into the relationship between gut microbiota dysbiosis and pain in SCD, highlighting the importance of gut microbial communities that may serve as potential targets for novel pain interventions.
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Affiliation(s)
- Yavnika Kashyap
- Departments of Pharmaceutical Sciences and Center for Biomolecular Science, University of Illinois, Chicago, IL, United States
| | - Zaijie Jim Wang
- Departments of Pharmaceutical Sciences and Center for Biomolecular Science, University of Illinois, Chicago, IL, United States
- Department of Neurology & Rehabilitation, and Sickle Cell Center, University of Illinois College of Medicine, Chicago, IL, United States
- Department of Biomedical Engineering, University of Illinois, Chicago, IL 60607, United States
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Sinkey RG, Ogunsile FJ, Kanter J, Bean C, Greenberg M. Society for Maternal-Fetal Medicine Consult Series #68: Sickle cell disease in pregnancy. Am J Obstet Gynecol 2024; 230:B17-B40. [PMID: 37866731 PMCID: PMC10961101 DOI: 10.1016/j.ajog.2023.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Pregnant individuals with sickle cell disease have an increased risk of maternal and perinatal morbidity and mortality. However, prepregnancy counseling and multidisciplinary care can lead to favorable maternal and neonatal outcomes. In this consult series, we summarize what is known about sickle cell disease and provide guidance for sickle cell disease management during pregnancy. The following are Society for Maternal-Fetal Medicine recommendations.
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Laksap S, Suanboon S, Punyamung M, Ruengdit C, Pornprasert S. A comparative evaluation of the analytical performances of premier resolution-high-performance liquid chromatography (PR-HPLC) with capillary zone electrophoresis (CZE) assays for the detection of hemoglobin variants and the quantitation of HbA 0, A 2, E, and F. Clin Chem Lab Med 2024; 0:cclm-2023-1458. [PMID: 38197862 DOI: 10.1515/cclm-2023-1458] [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: 12/17/2023] [Accepted: 01/04/2024] [Indexed: 01/11/2024]
Abstract
OBJECTIVES Hemoglobinopathies, including thalassemia and hemoglobin (Hb) variants, are common hematological disorders in tropical countries. Accurate and precise separation of hemoglobin types and reliable quantitation are necessary for differential diagnosis of these disorders. METHODS We have evaluated the analytical performances of premier resolution-high-performance liquid chromatography (PR-HPLC; Trinity Biotech, Co. Wicklow, Ireland) to assist in the presumptive diagnosis of thalassemia and Hb variants commonly found in Southeast Asian countries. HbA0, HbA2, HbE, and HbF levels were separated and quantified in 120 blood samples from unrelated adult subjects and compared with those analyzed by capillary zone electrophoresis (CZE; CAPILLARYS™ 2, Sebia, Norcross, GA, US). The Hb analysis patterns of Hb variants obtained from the PR-HPLC system were also compared to those obtained from HPLC (VARIANT II, β-thalassemia Short Program, Bio-Rad, Laboratories, Hercules, CA, US) and CZE systems. RESULTS The PR-HPLC had excellent precision with a coefficient of variation (CV) for HbA2 quantitation of 3.8 % within-run and 5.2 % between-run. The levels of HbA2/E quantified by the PR-HPLC system correlated well with those of the CZE system (r=0.997). In addition, thalassemia interpretation results obtained from the PR-HPLC and the CZE showed 100 % agreement. Moreover, chromatograms of the PR-HPLC were also comparable to those of VII-HPLC and CAP2-CZE electropherograms. CONCLUSIONS The PR-HPLC system would be applicable to diagnose common forms of thalassemia and Hb variants in Southeast Asia.
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Affiliation(s)
- Sirikwan Laksap
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Suphisara Suanboon
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Manoo Punyamung
- Associated Medical Sciences Clinical Service Center, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Chedtapak Ruengdit
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Sakorn Pornprasert
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
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Zhuang J, Jiang Y, Chen Y, Mao A, Chen J, Chen C. Third-generation sequencing identified two rare α-chain variants leading to hemoglobin variants in Chinese population. Mol Genet Genomic Med 2024; 12:e2365. [PMID: 38284449 PMCID: PMC10801340 DOI: 10.1002/mgg3.2365] [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: 09/23/2023] [Revised: 12/16/2023] [Accepted: 01/10/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Rare and novel variants of HBA1/2 and HBB genes resulting in thalassemia and hemoglobin (Hb) variants have been increasingly identified. Our goal was to identify two rare Hb variants in Chinese population using third-generation sequencing (TGS) technology. METHODS Enrolled in this study were two Chinese families from Fujian Province. Hematological screening was conducted using routine blood analysis and Hb capillary electrophoresis analysis. Routine thalassemia gene testing was carried out to detect the common mutations of α- and β-thalassemia in Chinese population. Rare or novel α- and β-globin gene variants were further investigated by TGS. RESULTS The proband of family 1 was a female aged 32, with decreased levels of mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), Hb A2, and abnormal Hb bands in zone 5 and zone 12. No common thalassemia mutations were detected by routine thalassemia analysis, while a rare α-globin gene variant Hb Jilin [α139(HC1)Lys>Gln (AAA>CAA); HBA2:c.418A>C] was identified by TGS. Subsequent pedigree analysis showed that the proband's son also harbored the Hb Jilin variant with slightly low levels of MCH, Hb A2, and abnormal Hb bands. The proband of family 2 was a male at 41 years of age, exhibiting normal MCV and MCH, but a low level of Hb A2 and an abnormal Hb band in zone 12 without any common α- and β-thalassemia mutations. The subsequent TGS detection demonstrated a rare Hb Beijing [α16(A14)Lys>Asn (AAG>AAT); HBA2:c.51G>T] variant in HBA2 gene. CONCLUSION In this study, for the first time, we present two rare Hb variants of Hb Jilin and Hb Beijing in Fujian Province, Southeast China, using TGS technology.
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Affiliation(s)
- Jianlong Zhuang
- Prenatal Diagnosis CenterQuanzhou Women's and Children's HospitalQuanzhouFujianChina
| | - Yuying Jiang
- Prenatal Diagnosis CenterQuanzhou Women's and Children's HospitalQuanzhouFujianChina
| | - Yu'e Chen
- Department of UltrasoundQuanzhou Women's and Children's HospitalQuanzhouFujianChina
| | - Aiping Mao
- Department of TGS Research and Development, Berry Genomics CorporationBeijingChina
| | - Junwei Chen
- Department of Children Health CareQuanzhou Women's and Children's HospitalQuanzhouChina
| | - Chunnuan Chen
- Department of NeurologyThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouFujianChina
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Koniali L, Flouri C, Kostopoulou MI, Papaioannou NY, Papasavva PL, Naiisseh B, Stephanou C, Demetriadou A, Sitarou M, Christou S, Antoniou MN, Kleanthous M, Patsali P, Lederer CW. Evaluation of Mono- and Bi-Functional GLOBE-Based Vectors for Therapy of β-Thalassemia by HBBAS3 Gene Addition and Mutation-Specific RNA Interference. Cells 2023; 12:2848. [PMID: 38132168 PMCID: PMC10741507 DOI: 10.3390/cells12242848] [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: 10/15/2023] [Revised: 12/10/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
Therapy via the gene addition of the anti-sickling βAS3-globin transgene is potentially curative for all β-hemoglobinopathies and therefore of particular clinical and commercial interest. This study investigates GLOBE-based lentiviral vectors (LVs) for βAS3-globin addition and evaluates strategies for an increased β-like globin expression without vector dose escalation. First, we report the development of a GLOBE-derived LV, GLV2-βAS3, which, compared to its parental vector, adds anti-sickling action and a transcription-enhancing 848-bp transcription terminator element, retains high vector titers and allows for superior β-like globin expression in primary patient-derived hematopoietic stem and progenitor cells (HSPCs). Second, prompted by our previous correction of HBBIVSI-110(G>A) thalassemia based on RNApol(III)-driven shRNAs in mono- and combination therapy, we analyzed a series of novel LVs for the RNApol(II)-driven constitutive or late-erythroid expression of HBBIVSI-110(G>A)-specific miRNA30-embedded shRNAs (shRNAmiR). This included bifunctional LVs, allowing for concurrent βAS3-globin expression. LVs were initially compared for their ability to achieve high β-like globin expression in HBBIVSI-110(G>A)-transgenic cells, before the evaluation of shortlisted candidate LVs in HBBIVSI-110(G>A)-homozygous HSPCs. The latter revealed that β-globin promoter-driven designs for monotherapy with HBBIVSI-110(G>A)-specific shRNAmiRs only marginally increased β-globin levels compared to untransduced cells, whereas bifunctional LVs combining miR30-shRNA with βAS3-globin expression showed disease correction similar to that achieved by the parental GLV2-βAS3 vector. Our results establish the feasibility of high titers for LVs containing the full HBB transcription terminator, emphasize the importance of the HBB terminator for the high-level expression of HBB-like transgenes, qualify the therapeutic utility of late-erythroid HBBIVSI-110(G>A)-specific miR30-shRNA expression and highlight the exceptional potential of GLV2-βAS3 for the treatment of severe β-hemoglobinopathies.
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Affiliation(s)
- Lola Koniali
- Department of Molecular Genetics Thalassaemia, The Cyprus Institute of Neurology & Genetics, 6 Iroon Avenue, 2371 Nicosia, Cyprus; (L.K.); (M.I.K.); (N.Y.P.); (P.L.P.); (B.N.); (C.S.); (A.D.); (M.K.)
| | - Christina Flouri
- Gene Expression and Therapy Group, Department of Medical and Molecular Genetics, King’s College London, Guy’s Hospital, London SE1 9RT, UK; (C.F.); (M.N.A.)
| | - Markela I. Kostopoulou
- Department of Molecular Genetics Thalassaemia, The Cyprus Institute of Neurology & Genetics, 6 Iroon Avenue, 2371 Nicosia, Cyprus; (L.K.); (M.I.K.); (N.Y.P.); (P.L.P.); (B.N.); (C.S.); (A.D.); (M.K.)
| | - Nikoletta Y. Papaioannou
- Department of Molecular Genetics Thalassaemia, The Cyprus Institute of Neurology & Genetics, 6 Iroon Avenue, 2371 Nicosia, Cyprus; (L.K.); (M.I.K.); (N.Y.P.); (P.L.P.); (B.N.); (C.S.); (A.D.); (M.K.)
| | - Panayiota L. Papasavva
- Department of Molecular Genetics Thalassaemia, The Cyprus Institute of Neurology & Genetics, 6 Iroon Avenue, 2371 Nicosia, Cyprus; (L.K.); (M.I.K.); (N.Y.P.); (P.L.P.); (B.N.); (C.S.); (A.D.); (M.K.)
| | - Basma Naiisseh
- Department of Molecular Genetics Thalassaemia, The Cyprus Institute of Neurology & Genetics, 6 Iroon Avenue, 2371 Nicosia, Cyprus; (L.K.); (M.I.K.); (N.Y.P.); (P.L.P.); (B.N.); (C.S.); (A.D.); (M.K.)
| | - Coralea Stephanou
- Department of Molecular Genetics Thalassaemia, The Cyprus Institute of Neurology & Genetics, 6 Iroon Avenue, 2371 Nicosia, Cyprus; (L.K.); (M.I.K.); (N.Y.P.); (P.L.P.); (B.N.); (C.S.); (A.D.); (M.K.)
| | - Anthi Demetriadou
- Department of Molecular Genetics Thalassaemia, The Cyprus Institute of Neurology & Genetics, 6 Iroon Avenue, 2371 Nicosia, Cyprus; (L.K.); (M.I.K.); (N.Y.P.); (P.L.P.); (B.N.); (C.S.); (A.D.); (M.K.)
| | - Maria Sitarou
- Thalassemia Clinic Larnaca, Larnaca General Hospital, 6301 Larnaca, Cyprus;
| | - Soteroula Christou
- Thalassemia Clinic Nicosia, Archbishop Makarios III Hospital, 1474 Nicosia, Cyprus;
| | - Michael N. Antoniou
- Gene Expression and Therapy Group, Department of Medical and Molecular Genetics, King’s College London, Guy’s Hospital, London SE1 9RT, UK; (C.F.); (M.N.A.)
| | - Marina Kleanthous
- Department of Molecular Genetics Thalassaemia, The Cyprus Institute of Neurology & Genetics, 6 Iroon Avenue, 2371 Nicosia, Cyprus; (L.K.); (M.I.K.); (N.Y.P.); (P.L.P.); (B.N.); (C.S.); (A.D.); (M.K.)
| | - Petros Patsali
- Department of Molecular Genetics Thalassaemia, The Cyprus Institute of Neurology & Genetics, 6 Iroon Avenue, 2371 Nicosia, Cyprus; (L.K.); (M.I.K.); (N.Y.P.); (P.L.P.); (B.N.); (C.S.); (A.D.); (M.K.)
| | - Carsten W. Lederer
- Department of Molecular Genetics Thalassaemia, The Cyprus Institute of Neurology & Genetics, 6 Iroon Avenue, 2371 Nicosia, Cyprus; (L.K.); (M.I.K.); (N.Y.P.); (P.L.P.); (B.N.); (C.S.); (A.D.); (M.K.)
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Hakami F, Alhazmi E, Busayli WM, Althurwi S, Darraj AM, Alamir MA, Hakami A, Othman RA, Moafa AI, Mahasi HA, Madkhali MA. Overview of the Association Between the Pathophysiology, Types, and Management of Sickle Cell Disease and Stroke. Cureus 2023; 15:e50577. [PMID: 38107212 PMCID: PMC10723021 DOI: 10.7759/cureus.50577] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 12/19/2023] Open
Abstract
Sickle cell disease (SCD) is a genetic blood disorder that affects hemoglobin and increases stroke risk, particularly in childhood. This review examines the pathophysiological association between SCD and stroke, the classification of stroke types, risk factors, diagnosis, management, prevention, and prognosis. A comprehensive literature search was conducted via PubMed, Scopus, and Cochrane databases. Relevant studies on SCD and stroke pathophysiology, classification, epidemiology, diagnosis, treatment, and prevention were identified. Sickle cell disease causes red blood cells to become rigid and sickle-shaped, obstructing blood vessels. Recurrent sickling alters cerebral blood flow and damages vessel walls, often leading to ischemic or hemorrhagic strokes (HS). These occur most frequently in childhood, with ischemic strokes (IS) being more common. Key risk factors include a prior transient ischemic attack (TIA), low hemoglobin, and a high leukocyte count. Neuroimaging is essential for diagnosis and determining stroke type. Primary prevention centers on blood transfusions and hydroxyurea for those at high risk. Acute treatment involves promptly restoring blood flow and managing complications. However, significant knowledge gaps remain regarding stroke mechanisms, optimizing screening protocols, and improving long-term outcomes. This review synthesizes current evidence on SCD and stroke to highlight opportunities for further research and standardizing care protocols across institutions. Ultimately, a holistic perspective is critical for mitigating the high risk of debilitating strokes in this vulnerable patient population.
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Affiliation(s)
- Faisal Hakami
- Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Essam Alhazmi
- Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Wafa M Busayli
- Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
| | | | | | | | - Alyaj Hakami
- Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Renad A Othman
- Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Amal I Moafa
- Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
| | | | - Mohammed Ali Madkhali
- Internal Medicine, and Hematology and Oncology, Faculty of Medicine, Jazan University, Jazan, SAU
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11
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Williams LA, Adamski J, Kinard TN, Ertz-Archambault NM, Lu Q, Gray K, Herrick JL, Su L, Padrnos L. The first reported use of red blood cell exchange to treat hemoglobin Evans with secondary methemoglobinemia. J Clin Apher 2023; 38:755-759. [PMID: 37665037 DOI: 10.1002/jca.22086] [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: 06/08/2023] [Revised: 07/31/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023]
Abstract
This manuscript describes a novel approach for treating patients with long-term sequelae from hemoglobin Evans (Hb Evans). After instituting conservative therapies for approximately 2 years, our patient's symptoms continually worsened. Therefore, we performed red blood cell exchange (RBCx) to reduce his Hb Evans percentage and his co-existing elevation of methemoglobin. Our assumptions of clinical benefit were based on our collective experience performing RBCx for patients with sickle cell disease. After the first exchange, pre- and post-laboratory results supported our approach and the patient experienced marked improvement in his clinical signs and symptoms. This report provides preliminary proof of principle for the use of RBCx to treat Hb Evans and other non-Hb S hemoglobinopathies.
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Affiliation(s)
- Lance A Williams
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Jill Adamski
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Theresa N Kinard
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | | | - Qun Lu
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Kristin Gray
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Jennifer L Herrick
- Department of Laboratory Medicine and Pathology (Hematopathology), Mayo Clinic, Rochester, Minnesota, USA
| | - Leon Su
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Leslie Padrnos
- Department of Hematology/Oncology, Mayo Clinic Hospital, Phoenix, Arizona, USA
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12
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Wildenberg NP, Rossi C, Kulozik AE, Kunz JB. Hb Santa Juana ( β 108(G10) Asn > Ser): a low oxygen affinity hemoglobin variant in a family of Bosnian background. Hematology 2023; 28:2184120. [PMID: 36867085 DOI: 10.1080/16078454.2023.2184120] [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] [Indexed: 03/04/2023] Open
Abstract
We present a family that carries the β-hemoglobin variant Hb Santa Juana (HBB:c.326A>G, β 108(G10) Asn>Ser), also known as Hb Serres, in three generations. All affected family members had an anomal hemoglobin fraction as detected by HPLC but normal blood count without evidence of anemia or hemolysis. Oxygen affinity (p50 (O2) = 31.9-40.4 mmHg) was decreased in all probands, compared to 24.9-28.1 mmHg in unaffected individuals. Clinical symptoms likely related to the hemoglobin variant were cyanosis during anaesthesia, while other complaints such as shortness of breath or dizziness were less clearly linked with the hemoglobin variant.
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Affiliation(s)
- N P Wildenberg
- Department of Pediatric Oncology, Hematology, and Immunology, University of Heidelberg, Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | - C Rossi
- Department of Pediatric Oncology, Hematology, and Immunology, University of Heidelberg, Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | - A E Kulozik
- Department of Pediatric Oncology, Hematology, and Immunology, University of Heidelberg, Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | - J B Kunz
- Department of Pediatric Oncology, Hematology, and Immunology, University of Heidelberg, Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
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13
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Asees MY, Shrateh ON, Jobran AW, Assi AS. Rare occurrence of hemoglobin Lepore variant in a Palestinian patient: a case report and brief literature review. Ann Med Surg (Lond) 2023; 85:5219-5222. [PMID: 37811104 PMCID: PMC10552947 DOI: 10.1097/ms9.0000000000001212] [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: 07/04/2023] [Accepted: 08/12/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction In hemoglobinopathies, a basic lesion alters the rate of globin synthesis or the structure of the globin in healthy hemoglobin (Hb). Genetic instructions are used to synthesize the polypeptide chains that make up globin chains. The kind and extent of the structural aberration of the Hb molecule are closely related to the clinical features. Hematologically, the heterozygous form of the Lepore syndrome has a pattern resembling minor thalassemia, and electrophoretically, it is characterized by aberrant Hb Lepore fractions at a rate of 5-15% and a decreased percentage of HbA and mildly increased HbF. Clinically speaking, Hb Lepore heterozygotes patients are asymptomatic and resemble the clinical picture of patients with mild thalassemia. Case Presentation A 28-year-old female came to our attention for assessment of generalized weakness and fatigue for a 4-month duration. Laboratory evaluation, including complete blood count, showed mild microcytic hypochromic anemia with parameters resembling the thalassemia trait. Iron profile studies were normal. Abdominal ultrasound showed mild splenomegaly. Hb electrophoresis was performed and showed an abnormal high-performance liquid chromatography pattern with an abnormal Hb band, mild elevated HbF, and mild reduction in HbA. The interpretation of the Hb electrophoresis curve suggested heterozygosity for beta chain variant Hb Lepore. Discussion and Conclusion Hb Lepore is one of the structural Hb variants with a characteristic fusion gene between the delta and beta chains. Hematologically, the heterozygous form of the Lepore syndrome has a pattern resembling the thalassemia trait. In Palestine, the prevalence of Hb Lepore, either homozygous or homozygous state, is unknown.
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Affiliation(s)
- Mohammad Y. Asees
- Professional Medical Laboratories, Department of Clinical Chemistry and Hematology, Ramallah
| | - Oadi N. Shrateh
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | - Ayuob S. Assi
- Professional Medical Laboratories, Department of Clinical Chemistry and Hematology, Ramallah
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14
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Banait S, Banait T, Shukla S, Mane S, Jain J. Bilateral Humeral Head Avascular Necrosis: A Rare Presentation in Sickle Cell Trait. Cureus 2023; 15:e44006. [PMID: 37746483 PMCID: PMC10517089 DOI: 10.7759/cureus.44006] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
Sickle cell disease (SCD) affects millions of people worldwide. It is an autosomal recessive hemoglobinopathy that occurs due to a point mutation in the sixth codon that replaces glutamic acid with valine in the beta-globin chain. Avascular necrosis (AVN), also known as osteonecrosis, is one of its complications. In this report, we present a case of a 25-year-old female with sickle cell trait without any comorbidities who presented to us with pain in both shoulder joints for three months and was diagnosed with AVN in bilateral shoulder joints. Appropriate treatment can dramatically reduce pain and improve the quality of life for these patients. This case drew our attention due to its rare presentation.
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Affiliation(s)
- Shashank Banait
- Department of Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research (DMIHER), Wardha, IND
| | - Tanvi Banait
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research (DMIHER), Wardha, IND
| | - Shivani Shukla
- Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Wardha, IND
| | - Supriya Mane
- Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Wardha, IND
| | - Jyoti Jain
- Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Wardha, IND
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15
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Kargutkar N, Nadkarni A. Effect of hydroxyurea on erythrocyte apoptosis in hemoglobinopathy patients. Expert Rev Hematol 2023; 16:685-692. [PMID: 37394969 DOI: 10.1080/17474086.2023.2231152] [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: 05/02/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Hydroxyurea (HU) therapy improves the clinical severity of patients with hemoglobinopathies. Few studies have documented some mechanisms of HU, but the exact mechanism of action is unknown. Phosphatidylserine on erythrocytes is responsible for apoptosis. In this study, we investigate the expression of phosphatidylserine on the erythrocytes surface of hemoglobinopathies before and after HU treatment. RESEARCH DESIGNS AND METHODS Blood samples from 45 thalassemia intermedia and 40 SCA and 30 HbE-b-thalassemia patients were analyzed before and after 3 and 6 months of HU treatment. The profile of phosphatidylserine was determined by flow-cytometry using the Annexin V-RBC apoptosis kit. RESULTS Hydroxyurea proved effective in improving clinical severity of hemoglobinopathies. After treatment with hydroxyurea, the percentage of phosphatidylserine-positive cells was significantly reduced in all 3 patient groups (p < 0.0001). Correlation analysis using different hematological parameters as independent variables and % phosphatidylserine as dependent variable showed a negative relationship with HbF, RBC, and hemoglobin in all 3 patient groups. CONCLUSION Hydroxyurea reduces the expression of phosphatidylserine on erythrocytes, contributing to the beneficial effects of this therapy. We suggest that the use of such a biological marker in conjunction with HbF levels may provide valuable insights into the biology and consequences of early RBC apoptosis.
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Affiliation(s)
- Neha Kargutkar
- ICMR-National Institute of Immunohaematology, King Edward Memorial Hospital, Mumbai, India
| | - Anita Nadkarni
- ICMR-National Institute of Immunohaematology, King Edward Memorial Hospital, Mumbai, India
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16
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Li EW, Walsh R, Ho PJ. Benign clinical phenotype of co-inherited congenital dyserythropoietic anaemia type I and heterozygous haemoglobin Lepore. Eur J Haematol 2023; 111:161-164. [PMID: 37037770 DOI: 10.1111/ejh.13974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/12/2023]
Affiliation(s)
- Eric Wenlong Li
- Institute of Haematology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Rebecca Walsh
- Randwick Genetics Laboratory, NSW Health Pathology, Randwick, New South Wales, Australia
| | - P Joy Ho
- Institute of Haematology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
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17
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Sabath DE. The role of molecular diagnostic testing for hemoglobinopathies and thalassemias. Int J Lab Hematol 2023. [PMID: 37211360 DOI: 10.1111/ijlh.14089] [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: 03/01/2023] [Accepted: 04/27/2023] [Indexed: 05/23/2023]
Abstract
Hemoglobin disorders are among the most common genetic diseases worldwide. Molecular diagnosis is helpful in cases where the diagnosis is uncertain and for genetic counseling. Protein-based diagnostic techniques are frequently adequate for initial diagnosis. Molecular genetic testing is pursued in some cases, particularly when a definitive diagnosis is not possible and especially for the purpose of assessing genetic risk for couples wanting to have children. The expertise available in the clinical hematology laboratory is essential for the diagnosis of patients with hemoglobin abnormalities. Initial diagnoses are made using protein-based techniques such as electrophoresis and chromatography. Based on these findings, genetic risk to an individual's offspring can be assessed. In the setting of β-thalassemia and other β-globin disorders, coincident α-thalassemia may be difficult to diagnose, which can have potentially serious consequences. In addition, unusual forms of β-thalassemia caused by deletions in the β-globin locus cannot be definitively characterized using standard techniques. Molecular diagnostic testing has an important role in the diagnosis of hemoglobin disorders and is important in the setting of genetic counseling. Molecular testing also has a role in prenatal diagnosis to identify fetuses affected by severe hemoglobinopathies and thalassemias.
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Affiliation(s)
- Daniel E Sabath
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
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18
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Malagù M, Longo F, Marchini F, Sirugo P, Capanni A, Clò S, Mari E, Culcasi M, Bertini M. Non-Vitamin K Antagonist Oral Anticoagulants in Patients with β-Thalassemia. Biology (Basel) 2023; 12:biology12040491. [PMID: 37106692 PMCID: PMC10136165 DOI: 10.3390/biology12040491] [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] [Received: 02/06/2023] [Revised: 03/18/2023] [Accepted: 03/23/2023] [Indexed: 04/29/2023]
Abstract
Background. Patients with β-thalassemia have a high incidence of atrial fibrillation (AF) and other supraventricular arrhythmias. The use of non-vitamin K antagonist oral anticoagulants (NOACs) for thromboembolic prophylaxis in patients with β-thalassemia has not been systematically evaluated. Methods. We enrolled patients with transfusion-dependent β-thalassemia, who were on treatment with NOACs for thromboembolic prophylaxis of supraventricular arrhythmias. Data on thromboembolic and bleeding events were collected. Results. Eighteen patients were enrolled. The patients had a history of AF (sixteen), typical atrial flutter (five), and atypical atrial flutter (four). The patients were treated with dabigatran (seven), apixaban (five), rivaroxaban (four) or edoxaban (two). The mean follow-up duration was 22 ± 15 months. No thromboembolic events were reported. No major bleedings were observed. Three patients had non-major bleeding events. Two patients reported dyspepsia during treatment with dabigatran and were shifted to a different NOAC. Conclusions. Our study suggests the efficacy and safety of NOACs in patients affected by transfusion-dependent β-thalassemia.
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Affiliation(s)
- Michele Malagù
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy
| | - Filomena Longo
- Day Hospital Thalassemia and Hemoglobinopathies, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy
| | - Federico Marchini
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy
| | - Paolo Sirugo
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy
| | - Andrea Capanni
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy
| | - Stefano Clò
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy
| | - Elisa Mari
- Day Hospital Thalassemia and Hemoglobinopathies, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy
| | - Martina Culcasi
- Day Hospital Thalassemia and Hemoglobinopathies, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy
| | - Matteo Bertini
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy
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19
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Chaemsaithong P, Luewan S, Taweevisit M, Chiangjong W, Pongchaikul P, Thorner PS, Tongsong T, Chutipongtanate S. Placenta-Derived Extracellular Vesicles in Pregnancy Complications and Prospects on a Liquid Biopsy for Hemoglobin Bart's Disease. Int J Mol Sci 2023; 24:5658. [PMID: 36982732 PMCID: PMC10055877 DOI: 10.3390/ijms24065658] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/18/2023] [Accepted: 02/22/2023] [Indexed: 03/18/2023] Open
Abstract
Extracellular vesicles (EVs) are nano-scaled vesicles released from all cell types into extracellular fluids and specifically contain signature molecules of the original cells and tissues, including the placenta. Placenta-derived EVs can be detected in maternal circulation at as early as six weeks of gestation, and their release can be triggered by the oxygen level and glucose concentration. Placental-associated complications such as preeclampsia, fetal growth restriction, and gestational diabetes have alterations in placenta-derived EVs in maternal plasma, and this can be used as a liquid biopsy for the diagnosis, prediction, and monitoring of such pregnancy complications. Alpha-thalassemia major ("homozygous alpha-thalassemia-1") or hemoglobin Bart's disease is the most severe form of thalassemia disease, and this condition is lethal for the fetus. Women with Bart's hydrops fetalis demonstrate signs of placental hypoxia and placentomegaly, thereby placenta-derived EVs provide an opportunity for a non-invasive liquid biopsy of this lethal condition. In this article, we introduced clinical features and current diagnostic markers of Bart's hydrops fetalis, extensively summarize the characteristics and biology of placenta-derived EVs, and discuss the challenges and opportunities of placenta-derived EVs as part of diagnostic tests for placental complications focusing on Bart's hydrop fetalis.
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Affiliation(s)
- Piya Chaemsaithong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Suchaya Luewan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiangmai University, Chiangmai 50200, Thailand
| | - Mana Taweevisit
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
- King Chulalongkorn Memorial Hospital and Thai Red Cross Society, Bangkok 10330, Thailand
| | - Wararat Chiangjong
- Pediatric Translational Research Unit, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Pisut Pongchaikul
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan 10540, Thailand
- Integrative Computational BioScience Center, Mahidol University, Nakhon Pathom 73170, Thailand
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool CH64 7TE, UK
| | - Paul Scott Thorner
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S1A8, Canada
| | - Theera Tongsong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiangmai University, Chiangmai 50200, Thailand
| | - Somchai Chutipongtanate
- Division of Epidemiology, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
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20
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Shah R, Shah A, Badawy SM. An evaluation of deferiprone as twice-a-day tablets or in combination therapy for the treatment of transfusional iron overload in thalassemia syndromes. Expert Rev Hematol 2023; 16:81-94. [PMID: 36755516 PMCID: PMC9992344 DOI: 10.1080/17474086.2023.2178409] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 10/14/2022] [Accepted: 02/06/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Regular blood transfusions in patients with thalassemia syndromes can cause iron overload resulting in complications including cirrhosis, heart problems, or endocrine abnormalities. To prevent iron overload toxicity in these patients, three iron chelators are currently FDA-approved for use: deferoxamine, deferasirox, and deferiprone. In the United States, deferiprone has been approved for three times daily dosing since 2011 and has recently gained approval for twice-daily administration. AREAS COVERED A PubMed literature search was performed with the keywords 'deferiprone' and 'thalassemia.' Relevant original research studying deferiprone's effects on transfusional iron overload in patients with thalassemia syndromes was included. Exclusion criteria included case reports and review papers. Deferiprone is effective at reducing serum ferritin levels in patients with iron overload. Twice-daily administration provides a similar level of iron chelation as three times daily dosing with a comparable side effect profile and increased patient acceptability. EXPERT OPINION New studies are highlighting deferiprone's potential for combination therapy with either deferoxamine or deferasirox to improve iron chelation. Deferiprone's ability to significantly decrease cardiac and liver iron content can be utilized in other transfusion-dependent hematologic conditions, as evidenced by its recent approval for use in the United States for sickle cell disease or other anemias.
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Affiliation(s)
- Richa Shah
- Division of Hematology, Oncology, and Stem Cell Transplant, Lurie Children’s Hospital of Chicago, Chicago, IL, 60611, USA
| | - Aashaka Shah
- University of Illinois College of Medicine, Chicago, IL, 60612, USA
| | - Sherif M. Badawy
- Division of Hematology, Oncology, and Stem Cell Transplant, Lurie Children’s Hospital of Chicago, Chicago, IL, 60611, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
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21
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Kangastupa P, Åkerman K, Risku S, Väisänen M, Kuusela R, Romppanen J, Kouki A, Sneck M, Itkonen O, Niemelä O. The prevalence of hemoglobin Tacoma in Finland detected by HbA1c capillary electrophoresis. Scand J Clin Lab Invest 2023; 83:51-57. [PMID: 36633442 DOI: 10.1080/00365513.2022.2164739] [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] [Indexed: 01/13/2023]
Abstract
Previous studies have identified occasional cases of heterozygous Hb Tacoma in areas that have attracted Finnish immigrants, especially in Sweden and North America, but large studies of this slightly unstable beta variant in vitro have not been carried out. Here we determined the prevalence of hemoglobin variants across Finland. A total of 5059 samples from 11 different hospital districts were analyzed using HbA1c capillary electrophoresis and reviewed for atypical profiles (HbA1c, Capillarys 3 Tera, Sebia). 38 heterozygous Hb Tacoma cases were found (0.75%). The prevalence was highest in South Ostrobothnia (2.0%), located in western Finland, and second highest in the neighboring provinces (1.0-1.4%), but only two districts were devoid of variants. Heterozygous Hb Tacoma was confirmed by genetic testing (NM_000518.5(HBB):c.93G > T (p.Arg31Ser)). In addition, five other variants were found, suggestive of HbE, Hb Helsinki (two cases) and an alpha variant, as interpreted from the electropherograms. The fifth variant, belonging to the South Ostrobothnian cohort, remained unknown at the time of the initial analyses, but was later interpreted as homozygous Hb Tacoma and confirmed by hemoglobin fraction analysis (Hemoglobin(E), Capillarys 3 Tera). In a subsequent retrospective study of the electropherograms of routine HbA1c diagnostics, altogether nine homozygous Hb Tacoma cases were identified in South Ostrobothnia. While heterozygous Hb Tacoma is usually an incidental finding, it interferes with several HbA1c assays. The present study is the first demonstration of homozygous Hb Tacoma. The clinical presentations of homozygous Hb Tacoma are not known and need to be addressed in future studies.
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Affiliation(s)
- Päivikki Kangastupa
- Department of Clinical Chemistry, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Kari Åkerman
- Department of Clinical Chemistry, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Sari Risku
- Department of Internal Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Matti Väisänen
- Department of Clinical Chemistry, Vaasa Central Hospital, Vaasa, Finland
| | | | | | - Annika Kouki
- City of Turku, Welfare Division, Health Care Services, Turku, Finland.,Turku University Hospital, Tykslab, Turku, Finland
| | - Mia Sneck
- Department of Clinical Chemistry, Helsinki University Hospital, Helsinki, Finland
| | - Outi Itkonen
- Department of Clinical Chemistry, Helsinki University Hospital, Helsinki, Finland
| | - Onni Niemelä
- Department of Clinical Chemistry, Seinäjoki Central Hospital, Seinäjoki, Finland.,Department of Laboratory Medicine, University of Tampere, Tampere, Finland
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22
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Li Z, Chen D, Shu Y, Yang J, Zhang J, Ming Wang, Wan K, Zhou Y, He X, Zou L, Yu C. A reliable and high throughput HPLC-HRMS method for the rapid screening of β-thalassemia and hemoglobinopathy in dried blood spots. Clin Chem Lab Med 2023; 61:1075-1083. [PMID: 36645719 DOI: 10.1515/cclm-2022-0706] [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: 07/21/2022] [Accepted: 12/20/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Traditional methods for β-thalassemia screening usually rely on the structural integrity of hemoglobin (Hb), which can be affected by the hemolysis of red blood cells and Hb degradation. Here, we aim to develop a reliable and high throughput method for rapid detection of β-thalassemia using dried blood spots (DBS). METHODS Hb components were extracted from a disc (3.2 mm diameter) punched from the DBS samples and digested by trypsin to produce a series of Hb-specific peptides. An analytical system combining high-resolution mass spectrometry and high-performance liquid chromatography was used for biomarker selection. The selected marker peptides were used to calculate delta/beta (δ/β) and beta-mutated/beta (βM/β) globin ratios for disease evaluation. RESULTS Totally, 699 patients and 629 normal individuals, aged 3 days to 89 years, were recruited for method construction. Method assessment showed both the inter-assay and intra-assay relative standard deviation values were less than 10.8%, and the limits of quantitation for the proteo-specific peptides were quite low (1.0-5.0 μg/L). No appreciable matrix effects or carryover rates were observed. The extraction recoveries ranged from 93.8 to 128.7%, and the method was shown to be stable even when the samples were stored for 24 days. Prospective applications of this method in 909 participants also indicated good performance with a sensitivity of 100% and a specificity of 99.6%. CONCLUSIONS We have developed a fast, high throughput and reliable method for screening of β-thalassemia and hemoglobinopathy in children and adults, which is expected to be used as a first-line screening assay.
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Affiliation(s)
- Ziwei Li
- Center for Clinical Molecular Medicine & Newborn Screening, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Engineering Research Center of Stem Cell Therapy, Chongqing, P.R. China.,Chongqing University Fuling Hospital, Chongqing, P.R. China
| | - Deling Chen
- Department of Cardiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P.R. China.,Chongqing University Fuling Hospital, Chongqing, P.R. China
| | - Yan Shu
- Chongqing University Fuling Hospital, Chongqing, P.R. China
| | - Jing Yang
- Center for Clinical Molecular Medicine & Newborn Screening, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Engineering Research Center of Stem Cell Therapy, Chongqing, P.R. China
| | - Juan Zhang
- Center for Clinical Molecular Medicine & Newborn Screening, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Engineering Research Center of Stem Cell Therapy, Chongqing, P.R. China
| | - Ming Wang
- Center for Clinical Molecular Medicine & Newborn Screening, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Engineering Research Center of Stem Cell Therapy, Chongqing, P.R. China
| | - Kexing Wan
- Center for Clinical Molecular Medicine & Newborn Screening, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Engineering Research Center of Stem Cell Therapy, Chongqing, P.R. China
| | - Yinpin Zhou
- Department of Cardiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P.R. China.,Chongqing University Fuling Hospital, Chongqing, P.R. China
| | - Xiaoyan He
- Center for Clinical Molecular Medicine & Newborn Screening, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Engineering Research Center of Stem Cell Therapy, Chongqing, P.R. China
| | - Lin Zou
- Center for Clinical Molecular Medicine & Newborn Screening, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Engineering Research Center of Stem Cell Therapy, Chongqing, P.R. China
| | - Chaowen Yu
- Center for Clinical Molecular Medicine & Newborn Screening, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Engineering Research Center of Stem Cell Therapy, Chongqing, P.R. China
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23
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Bin Zuair A, Aldossari S, Alhumaidi R, Alrabiah M, Alshabanat A. The Burden of Sickle Cell Disease in Saudi Arabia: A Single-Institution Large Retrospective Study. Int J Gen Med 2023; 16:161-171. [PMID: 36659915 PMCID: PMC9844992 DOI: 10.2147/ijgm.s393233] [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: 10/13/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Purpose Sickle cell disease (SCD) is a significant burden for patients and healthcare systems due to multiple factors, including high readmission rates. This study aimed to determine the general characteristics, etiology of admissions, annual admission rate, length of stay, and readmission rate of patients with SCD. Patients and Methods This retrospective observational study included all adult patients with SCD admitted to the General Internal Medicine (GIM) unit between 2016 and 2021. Results There were 160 patients (mean age, 31.08 ± 9.06 years; 51.25% female) with SCD included in this study. Most originated from southern Saudi Arabia (45.62%). The average annual number of emergency department (ED) visits was 4, and approximately 19% of patients had ≥3 annual admissions. The mean length of stay was 6 days. The readmission rates at 7, 30, 60, and 90 days were 8%, 24.5%, 13.6%, and 10.8%, respectively. Conclusion SCD generates a significant economic burden on the Saudi society and the effects on the healthcare system and patients' quality of life are evident in the high ED visits, readmission rates and prolonged hospitalization. Thereupon we advocate the implementation of sickle cell disease-specialized multidisciplinary clinics.
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Affiliation(s)
- Amerah Bin Zuair
- Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh, Saudi Arabia,Correspondence: Amerah Bin Zuair, Internal Medicine, King Saud University Medical City, Riyadh, Saudi Arabia, Tel +966558765609, Email
| | - Sheikhah Aldossari
- Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh, Saudi Arabia
| | - Rand Alhumaidi
- Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh, Saudi Arabia
| | - Maha Alrabiah
- Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdulmajeed Alshabanat
- Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh, Saudi Arabia
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24
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Muacevic A, Adler JR, Viazzi F, Paoletti E, Esposito P. Kidney Transplantation in a Patient Affected by Sickle Cell Trait: A Case Report and State-of-the-Art Review. Cureus 2023; 15:e33400. [PMID: 36751159 PMCID: PMC9899094 DOI: 10.7759/cureus.33400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2023] [Indexed: 01/07/2023] Open
Abstract
Chronic kidney disease (CKD) is a common feature of sickle cell disease (SCD). The awareness of the clinical presentation and renal involvement in patients affected by hemoglobinopathies is greatly needed. Patient management is particularly complex, especially with kidney transplantation. We, therefore, report the case of a 56-year-old patient affected by sickle cell trait who underwent kidney transplantation. This case will underline all the various challenges the nephrologist must face in this clinical setting and their management.
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25
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Öztürk Z, Küpesiz OA, Karasu G, Uygun V, Oygür N, Yeşilipek MA. Newborn screening for sickle cell anemia in Antalya, Türkiye. Turk J Pediatr 2023; 65:959-963. [PMID: 38204310 DOI: 10.24953/turkjped.2023.17] [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: 01/12/2024]
Abstract
BACKGROUND In a screening study conducted on adults, the prevalence of sickle cell traits in Antalya was found to be 0.24%. Since no screening studies have been conducted in the neonatal period in our region, the exact incidence has not been determined. In this study, we aim to report our experience of neonatal screening for sickle cell disease in Antalya, Türkiye. METHODS During a 14-month period, 2562 heel prick blood samples, taken on filter paper from Akdeniz University Hospital, Antalya Education and Research Hospital and Antalya Atatürk State Hospital and four other healthcare centers, were studied using the high pressure liquid chromatography method. Blood samples were studied using the `Sickle Cell Short Program` test method on a Bio Rad Variant device. RESULTS In the study, no patients with sickle cell disease were identified. Four newborns who were sickle cell carriers (0.15%) and two newborns who were Hemoglobin D carriers (0.08 %), were found. CONCLUSION Considering the efficiency and cost calculations made as a result of the data obtained from our study, it was concluded that sickle cell screening would not be effective in newborns. It seems more effective and economical to screen the children of parents, who are found to be at risk for Hemoglobin S carriage as a result of premarital tests.
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Affiliation(s)
- Zeynep Öztürk
- Department of Pediatric Hematology, Akdeniz University Faculty of Medicine, Antalya
| | - O Alphan Küpesiz
- Department of Pediatric Hematology, Akdeniz University Faculty of Medicine, Antalya
| | - Gülsün Karasu
- Department of Pediatric Bone Marrow Transplantation Unit, Medical Park Göztepe Hospital, İstanbul
| | - Vedat Uygun
- Department of Pediatric Bone Marrow Transplantation Unit, Medical Park Antalya Hospital, İstinye University Faculty of Medicine, Antalya
| | - Nihal Oygür
- Division of Neonatology, Department of Pediatrics, Akdeniz University Faculty of Medicine, Antalya, Türkiye
| | - M Akif Yeşilipek
- Department of Pediatric Bone Marrow Transplantation Unit, Medical Park Antalya Hospital, İstinye University Faculty of Medicine, Antalya
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26
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Shaw J, Ray R, Bhattacharjee S, Dasgupta AK, Bhattacharyya M. Pattern of hemoglobinopathy among the young tribes of West Bengal: A completely different scenario from Rest of India. Indian J Public Health 2023; 67:159-161. [PMID: 37039223 DOI: 10.4103/ijph.ijph_766_22] [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: 04/12/2023] Open
Abstract
Hemoglobinopathy is a major concern among the tribal population which constitutes 8.6% of the total population, and West Bengal (WB) is the home to 5.3 million tribes. The present study was conducted on 52,880 tribal school students from all the districts of WB. Written informed consent and peripheral blood were collected for complete blood count and high-performance liquid chromatography analysis. Beta trait was 5.3%, sickle trait was 2.35%, and hemoglobin (Hb) E (HbE) trait was 1.4% in this population. About 37.8% of beta trait belonged to the Santal tribe and 21.5% belonged to Oraon. HbS is mainly found in Alipurduar and Jalpaiguri districts at the prevalence of 3.69% and 5.96%, respectively. HbE trait is found at 6.06% in Alipurduar, of which 51% of cases are from Mech tribe only found in this district. Unlike central and Western parts of India, HbS trait in WB was significantly low among the tribes. A high prevalence of consanguinity among the tribes is considered responsible for the high rate of hemoglobinopathy.
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Affiliation(s)
- Jyoti Shaw
- Research Associate, Institute of Hematology and Transfusion Medicine, Department of Hematology of Medical College and Hospital, Kolkata, West Bengal, India
| | - Rudra Ray
- Research Associate, Institute of Hematology and Transfusion Medicine, Department of Hematology of Medical College and Hospital, Kolkata, West Bengal, India
| | - Sunistha Bhattacharjee
- Senior Research Fellow, Institute of Hematology and Transfusion Medicine, Department of Hematology of Medical College and Hospital, Kolkata, West Bengal, India
| | - Anjan Kumar Dasgupta
- Ex-Professor, Department of Biochemistry, University of Calcutta, Kolkata, West Bengal, India
| | - Maitreyee Bhattacharyya
- Professor and Director, Institute of Hematology and Transfusion Medicine, Department of Hematology of Medical College and Hospital, Kolkata, West Bengal, India
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27
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Muacevic A, Adler JR, Fontenot A, Khan MW. Rare Combinational Hemoglobinopathies. Cureus 2022; 14:e32327. [PMID: 36628031 PMCID: PMC9825142 DOI: 10.7759/cureus.32327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2022] [Indexed: 12/13/2022] Open
Abstract
Hemoglobinopathies are genetic defects that result in the abnormal formation and composition of globin chains in the hemoglobin molecule. Sickle cell disease is one of the more common forms of genetic malformation, while Hemoglobin (Hb) Arab, Lepore, Korle-Bu, Kansas, D-Punjab, and Hasharon are uncommon presentations. Herein, we describe the case of a young patient who presented with a low hemoglobin level and was subsequently diagnosed with a rare combination of Hemoglobin Korle-Bu, D-Punjab, and sickle cell trait.
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28
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Ropero Gradilla P, Raya JM, González FA, Rochas S, Ferrer-Benito S, Nieto JM, Martín-Santos T, Barrios M, Gutiérrez-Murillo L, Villegas A, Benavente C. Hb Nivaria: A New Hemoglobin Variant with a Shortened α-Globin Chain [ α139(HC1)Lys →Stop; HBA1: c.418A>T]. Hemoglobin 2022; 46:344-346. [PMID: 36847654 DOI: 10.1080/03630269.2023.2172430] [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] [Indexed: 03/01/2023]
Abstract
We report a novel hemoglobin (Hb) variant found in a Spanish individual from Santa Cruz de Tenerife, the Canary Islands in Spain. The proband was a 39-year-old male. High performance liquid chromatography (HPLC) displayed an unknown peak (19.3%) at a retention time of 1.3 min. eluting before Hb A0. Capillary zone electrophoresis (CZE) showed an abnormal peak (20.0%) in zone 12. Direct DNA sequencing of the α-globin genes revealed heterozygosity for a nonsense mutation at codon 139 (AAA>TAA), causing a lysine to stop codon substitution [α139(HC1)Lys→Stop; HBA1: c.418A>T]. We decided to name the variant Hb Nivaria (Tenerife) for the place of birth and residence of the proband.
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Affiliation(s)
- Paloma Ropero Gradilla
- Servicio de Hematología y Hemoterapia. Hospital Clínico San Carlos, Madrid, España.,Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España
| | - José María Raya
- Servicio de Hematología y Hemoterapia, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Islas Canarias, España
| | - Fernando Ataúlfo González
- Servicio de Hematología y Hemoterapia. Hospital Clínico San Carlos, Madrid, España.,Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España
| | - Sara Rochas
- Servicio de Hematología y Hemoterapia. Hospital Clínico San Carlos, Madrid, España.,Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España
| | - Sara Ferrer-Benito
- Servicio de Hematología y Hemoterapia. Hospital Clínico San Carlos, Madrid, España.,Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España
| | - Jorge M Nieto
- Servicio de Hematología y Hemoterapia. Hospital Clínico San Carlos, Madrid, España.,Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España
| | - Taida Martín-Santos
- Servicio de Hematología y Hemoterapia, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Islas Canarias, España
| | - Marcelo Barrios
- Servicio de Hematología y Hemoterapia, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Islas Canarias, España
| | - Lorena Gutiérrez-Murillo
- Servicio de Hematología y Hemoterapia, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Islas Canarias, España
| | - Ana Villegas
- Servicio de Hematología y Hemoterapia. Hospital Clínico San Carlos, Madrid, España
| | - Celina Benavente
- Servicio de Hematología y Hemoterapia. Hospital Clínico San Carlos, Madrid, España.,Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España
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29
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Feugray G, Kasonga F, Grall M, Dumesnil C, Benhamou Y, Brunel V, Le Cam Duchez V, Lahary A, Billoir P. Investigation of thrombin generation assay to predict vaso-occlusive crisis in adulthood with sickle cell disease. Front Cardiovasc Med 2022; 9:883812. [PMID: 36277754 PMCID: PMC9579298 DOI: 10.3389/fcvm.2022.883812] [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: 02/25/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Sickle cell disease (SCD) is an inherited hemoglobinopathy disorder. The main consequence is synthesis of hemoglobin S leading to chronic hemolysis associated with morbidity. The aim of this study was to investigate Thrombin Generation Assay (TGA) to assess hypercoagulability in SCD and TGA parameters as biomarkers of vaso-occlusive crisis (VOC) risk and hospitalization within 1 year. Materials and methods We performed TGA in platelet poor plasma (PPP) with 1 pM of tissue factor and 4 μM of phospholipid-standardized concentration, in duplicate for patients and controls. We measured thrombomodulin (TM), soluble endothelial Protein C Receptor and Tissue Factor Pathway Inhibitor (TFPI). Results A total of 113 adult patients with SCD, 83 at steady state and 30 during VOC, and 25 healthy controls matched on age and gender were included. Among the 83 patients at steady state, (36 S/S-1 S/β0, 20 S/Sα3.7, and 19 S/C-7 S/β+) 28 developed a VOC within 1 year (median: 4 months [2.25–6]). We observed an increase of peak and velocity associated with a shortening of lagtime and time to peak (TTP) and no difference of endogenous thrombin potential (ETP) in patients compared to controls. TFPI (p < 0.001) and TM (p = 0.006) were significantly decreased. TGA confirmed hypercoagulability in all SCD genotypes and clinical status. The association of ETP > 1,207 nM.min and peak >228.5 nM presented a sensitivity of 73.5% and a specificity of 93.9% to predict VOC development within 1 year. Conclusion We have demonstrated a hypercoagulable state in SCD associated with chronic hemolysis. These preliminary findings suggest that TGA parameters, as ETP and peak, could be used to predict VOC development within 1 year.
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Affiliation(s)
- Guillaume Feugray
- Vascular Hemostasis Unit, CHU Rouen, Normandie Université, UNIROUEN, INSERM U1096, Rouen, France
| | | | | | - Cécile Dumesnil
- Department of Pediatric Onco-Hematology, CHU Rouen, Rouen, France
| | - Ygal Benhamou
- Department of Internal Medicine, CHU Rouen, Normandie Université, UNIROUEN, INSERM U1096, Rouen, France
| | - Valery Brunel
- Department of General Biochemistry, CHU Rouen, Rouen, France
| | - Véronique Le Cam Duchez
- Vascular Hemostasis Unit, CHU Rouen, Normandie Université, UNIROUEN, INSERM U1096, Rouen, France
| | | | - Paul Billoir
- Vascular Hemostasis Unit, CHU Rouen, Normandie Université, UNIROUEN, INSERM U1096, Rouen, France,*Correspondence: Paul Billoir, ; orcid.org/0000-0001-5632-7713
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30
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Muacevic A, Adler JR. Profile of Hemoglobin D (HbD) Disease in Eastern Uttar Pradesh: A Single-Center Experience. Cureus 2022; 14:e30782. [PMID: 36337804 PMCID: PMC9621097 DOI: 10.7759/cureus.30782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 11/21/2022] Open
Abstract
Hemoglobin D (HbD) disease was identified in 31 samples from 15 families out of the 2560 samples (1.20%) analyzed for variant Hbs. There were five patients with HbSD disease, three with HbDβ disease, and the remaining 23 were HbD trait. Patients with HbSD disease had a variable clinical presentation with a pair of siblings being transfusion dependent although the age of first blood transfusion was different in the two patients. The one with high HbF started transfusions much later. None of them had symptoms related to sickling. Patients with HbDβ also had a variable presentation with only one of them being transfusion-dependent. All patients with HbSD and HbDβ disease were started on hydroxyurea. Persons with HbD trait were asymptomatic with half of them having normal Hb. The remaining half had mild microcytic hypochromic anemia. All the families with HbD disease were natives of this region and not migrants from other states. Although HbD disease has not been reported from this region in previous studies, clinicians need to be aware of this entity as it can give rise to symptomatic disease in some cases if associated with beta-thalassemia or sickle cell trait.
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31
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Sri VLP, Sreeja C, Muthukumar RS, Nachiammai N, Jayaraj M, Priya AHH. HBE homozygous haemoglobinpathy - Fortuitous finding. J Oral Maxillofac Pathol 2022; 26:580-582. [PMID: 37082065 PMCID: PMC10112082 DOI: 10.4103/jomfp.jomfp_98_22] [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: 02/22/2022] [Revised: 04/13/2022] [Accepted: 04/25/2022] [Indexed: 04/22/2023] Open
Abstract
A 24-year-old male patient presented with the principal complaint of deposits on his teeth and gingival pigmentation. After examination, he was diagnosed with chronic generalized gingivitis. He was further referred for pre-procedural routine blood investigations. Bleeding time, clotting time, and his random blood sugar values were normal. CBC report revealed the presence of erythrocytosis with microcytic hypochromic red blood cells. Following this peripheral smear was taken which reveals the presence of polychromatophils, target cells and a few spherocytes. Haemoglobin electrophoresis by high-performance liquid chromatography (HPLC) was performed which disclosed 90.8% of HbE, suggestive of homozygous haemoglobinopathy. He had no other associated systemic findings, and there was no relevant family history. The patient was informed about his condition and stated to have pre-marital and pre-natal genetic counselling in the future. The patient being a carrier of the thalassaemic trait happened to know his condition incidentally, which could prevent future complications.
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Affiliation(s)
- V. L. Premika Sri
- Department of Oral and Maxillofacial Pathology, Chettinad Dental College and Research Institute, Chennai, Tamil Nadu, India
| | - C Sreeja
- Department of Oral and Maxillofacial Pathology, Chettinad Dental College and Research Institute, Chennai, Tamil Nadu, India
| | - R. Sathish Muthukumar
- Department of Oral and Maxillofacial Pathology, Chettinad Dental College and Research Institute, Chennai, Tamil Nadu, India
| | - N. Nachiammai
- Department of Oral and Maxillofacial Pathology, Chettinad Dental College and Research Institute, Chennai, Tamil Nadu, India
| | - Merlin Jayaraj
- Department of Oral and Maxillofacial Pathology, Chettinad Dental College and Research Institute, Chennai, Tamil Nadu, India
| | - A. H. Harini Priya
- Department of Oral and Maxillofacial Pathology, Chettinad Dental College and Research Institute, Chennai, Tamil Nadu, India
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Migotsky M, Beestrum M, Badawy SM. Recent Advances in Sickle-Cell Disease Therapies: A Review of Voxelotor, Crizanlizumab, and L-glutamine. Pharmacy (Basel) 2022; 10:123. [PMID: 36287444 PMCID: PMC9610018 DOI: 10.3390/pharmacy10050123] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/13/2022] [Accepted: 09/17/2022] [Indexed: 12/03/2022] Open
Abstract
Sickle-cell disease (SCD) is an inherited hemoglobinopathy, causing lifelong complications such as painful vaso-occlusive episodes, acute chest syndrome, stroke, chronic anemia, and end-organ damage, with negative effects on quality of life and life expectancy. Within the last five years, three new treatments have been approved: L-glutamine in 2017 and crizanlizumab and voxelotor in 2019. We conducted a literature search of these three medications, and of the 31 articles meeting inclusion criteria, 6 studied L-glutamine, 9 crizanlizumab, and 16 voxelotor. Treatment with L-glutamine was associated with decrease in pain crises, hospitalizations, and time to first and second crises, with a decrease in RBC transfusion rate. Barriers to filling and taking L-glutamine included insurance denial, high deductible, and intolerability, especially abdominal pain. Crizanlizumab was associated with a reduction in pain crises and time to first crisis, with reduction in need for opioid use. Adverse effects of crizanlizumab include headache, nausea, insurance difficulty, and infusion reactions. Voxelotor was associated with increased hemoglobin and decreased markers of hemolysis. Barriers for voxelotor use included insurance denial and side effects such as headache, rash, and diarrhea. These three medications represent exciting new therapies and are generally well-tolerated though price and insurance approval remain potential barriers to access. Other studies are ongoing, particularly in the pediatric population, and more real-world studies are needed. The objective of this article is to evaluate post-approval studies of crizanlizumab, voxelotor, and L-glutamine in SCD, with a focus on real-world efficacy, side effects, and prescribing data.
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Affiliation(s)
- Michael Migotsky
- Department of Medical Education, McGaw Medical Center, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
| | - Molly Beestrum
- Galter Health Sciences Library, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Sherif M. Badawy
- Division of Hematology, Oncology, and Stem Cell Transplant, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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Saha D, Chowdhury PK, Panja A, Pal D, Nayek K, Chakraborty G, Sharma P, Das R, Basu S, Chatterjee R, Basu A. Effect of deletions in the α-globin gene on the phenotype severity of β-thalassemia. Hemoglobin 2022; 46:118-123. [PMID: 36000542 DOI: 10.1080/03630269.2022.2088381] [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] [Indexed: 11/04/2022]
Abstract
Thalassemia is the most common inherited hemoglobinopathy worldwide. Variation of clinical symptoms in this hemoglobinopathy entails differences in disease-onset and transfusion requirements. The aim of this study was to investigate the role of α-globin gene deletions in modulating the clinical heterogeneity of β-thalassemia (β-thal) syndromes. A total number 270 β-thal subjects were enrolled. Hematological parameters were recorded. β-Globin mutations were determined by amplified refractory mutation system-polymerase chain reaction (ARMS-PCR), gap-PCR and Sanger sequencing. α-Globin gene deletions were determined by multiplex PCR. Out of 270 β-thal subjects, 19 carried β+/β+, 74 had β0/β0 and 177 had the β0/β+ genotype. When we determined the severity of the different β-thal subjects in coinherited with the α gene deletion, it was revealed that, 84.2% β+/β+ subjects carried a non severe phenotype and did not have an α gene deletion. Of the β0/β0 individuals, 95.9% presented a severe phenotype, irrespective of α-globin gene deletions. In cases with the β0/β+ genotype, 19.2% subjects also carried a deletion on the α gene. Of these, 61.8% presented a non severe phenotype and 38.2% were severely affected. Only in the β0/β+ category did α gene deletions make a significant contribution (p < 0.001) toward alleviation of clinical severity. Therefore, it can be stated that α-globin gene deletions play a role in ameliorating the phenotype in patients with a β+/β0 genotype.
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Affiliation(s)
- Dipankar Saha
- Department of Zoology, The University of Burdwan, Purbo Barddhaman, West Bengal, India
| | | | - Amrita Panja
- Department of Zoology, The University of Burdwan, Purbo Barddhaman, West Bengal, India
| | - Debashis Pal
- Department of Zoology, The University of Burdwan, Purbo Barddhaman, West Bengal, India
| | - Kaustav Nayek
- Department of Pediatric Medicine, Burdwan Medical College and Hospital, Purbo Barddhaman, West Bengal, India
| | - Gispati Chakraborty
- Burdwan University Health Centre, The University of Burdwan, Purbo Barddhaman, West Bengal, India
| | - Prashant Sharma
- Department of Haematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reena Das
- Department of Haematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surupa Basu
- Department of Haematology, Institute of Child Health, Kolkata, West Bengal, India
| | | | - Anupam Basu
- Department of Zoology, The University of Burdwan, Purbo Barddhaman, West Bengal, India
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Wu SM, Jiang F, Li C, Guo ZT, Huang SR, Li DZ. Hb Wanjiang: A New β-Globin Chain Variant with Two Amino Acid Substitutions ( HBB: c.255_264delinsTTTTTCTCAG). Hemoglobin 2022; 46:129-131. [PMID: 35950878 DOI: 10.1080/03630269.2022.2085113] [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] [Indexed: 11/04/2022]
Abstract
We report a new hemoglobin (Hb) variant that we have named Hb Wanjiang (HBB: c.255_264delinsTTTTTCTCAG). We identified this variant in a Chinese man by the next-generation sequencing (NGS) method. The father of the proband also carried the same variant. This variant results from a 10 bp deletion at codons 84-87 of the β-globin chain, replaced with 10 nucleotides coming from the δ-globin gene at the same position, leading to the substitution of two amino acids in the peptide chain with no change in the β-globin chain length. The heterozygotes had a normal hematological feature with no abnormal Hb variant detectable on capillary electrophoresis (CE) and high performance liquid chromatography (HPLC). The combination of Hb Wanjiang and β-thalassemia (β-thal) was not found to aggravate anemia.
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Affiliation(s)
- Shao-Min Wu
- Prenatal Diagnosis Center, Affiliated Dongguan Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, People's Republic of China
| | - Fan Jiang
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou, People's Republic of China
| | - Chan Li
- Prenatal Diagnosis Center, Affiliated Dongguan Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, People's Republic of China
| | - Zhen-Tian Guo
- Clinical Laboratory, Affiliated Dongguan Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, People's Republic of China
| | - Su-Ran Huang
- Department of Obstetrics and Gynecology, Affiliated Dongguan Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, People's Republic of China
| | - Dong-Zhi Li
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou, People's Republic of China
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Kalaigar SS, Rajashekar RB, Nataraj SM, Vishwanath P, Prashant A. Bioinformatic Tools for the Identification of MicroRNAs Regulating the Transcription Factors in Patients with β-Thalassemia. Bioinform Biol Insights 2022; 16:11779322221115536. [PMID: 35935529 PMCID: PMC9354123 DOI: 10.1177/11779322221115536] [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: 04/26/2022] [Accepted: 07/02/2022] [Indexed: 11/20/2022] Open
Abstract
β-thalassemia is a significant health issue worldwide, with approximately 7% of the world’s population having defective hemoglobin genes. MicroRNAs (miRNAs) are short noncoding RNAs regulating gene expression at the post-transcriptional level by targeting multiple gene transcripts. The levels of fetal hemoglobin (HbF) can be increased by regulating the expression of the γ-globin gene using the suppressive effects of miRNAs on several transcription factors such as MYB, BCL11A, GATA1, and KLF. An early step in discovering miRNA:mRNA target interactions is the computational prediction of miRNA targets that can be later validated with wet-lab investigations. This review highlights some commonly employed computational tools such as miRBase, Target scan, DIANA-microT-CDS, miRwalk, miRDB, and micro-TarBase that can be used to predict miRNA targets. Upon comparing the miRNA target prediction tools, 4 main aspects of the miRNA:mRNA target interaction are shown to include a few common features on which most target prediction is based: conservation sites, seed match, free energy, and site accessibility. Understanding these prediction tools’ usage will help users select the appropriate tool and interpret the results accurately. This review will, therefore, be helpful to peers to quickly choose a list of the best miRNAs associated with HbF induction. Researchers will obtain significant results using these bioinformatics tools to establish a new important concept in managing β-thalassemia and delivering therapeutic strategies for improving their quality of life.
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Affiliation(s)
- Sumayakausar S Kalaigar
- Center for Medical Genomics & Counselling, Department of Biochemistry, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, India
| | | | - Suma M Nataraj
- Center for Medical Genomics & Counselling, Department of Biochemistry, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, India.,Special Interest Group-Human Genomics & Rare Disorders (SIG-HGRD), JSS Academy of Higher Education and Research, Mysore, India
| | - Prashant Vishwanath
- Center for Medical Genomics & Counselling, Department of Biochemistry, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, India.,Special Interest Group-Human Genomics & Rare Disorders (SIG-HGRD), JSS Academy of Higher Education and Research, Mysore, India
| | - Akila Prashant
- Center for Medical Genomics & Counselling, Department of Biochemistry, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, India.,Special Interest Group-Human Genomics & Rare Disorders (SIG-HGRD), JSS Academy of Higher Education and Research, Mysore, India
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Kountouris P, Stephanou C, Lederer CW, Traeger‐Synodinos J, Bento C, Harteveld CL, Fylaktou E, Koopmann TT, Halim‐Fikri H, Michailidou K, Nfonsam LE, Waye JS, Zilfalil BA, Kleanthous M. Adapting the ACMG/AMP variant classification framework: A perspective from the ClinGen Hemoglobinopathy Variant Curation Expert Panel. Hum Mutat 2022; 43:1089-1096. [PMID: 34510646 PMCID: PMC9545675 DOI: 10.1002/humu.24280] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/10/2021] [Accepted: 09/08/2021] [Indexed: 12/29/2022]
Abstract
Accurate and consistent interpretation of sequence variants is integral to the delivery of safe and reliable diagnostic genetic services. To standardize the interpretation process, in 2015, the American College of Medical Genetics and Genomics (ACMG) and the Association for Molecular Pathology (AMP) published a joint guideline based on a set of shared standards for the classification of variants in Mendelian diseases. The generality of these standards and their subjective interpretation between laboratories has prompted efforts to reduce discordance of variant classifications, with a focus on the expert specification of the ACMG/AMP guidelines for individual genes or diseases. Herein, we describe our experience as a ClinGen Variant Curation Expert Panel to adapt the ACMG/AMP criteria for the classification of variants in three globin genes (HBB, HBA2, and HBA1) related to recessively inherited hemoglobinopathies, including five evidence categories, as use cases demonstrating the process of specification and the underlying rationale.
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Affiliation(s)
- Petros Kountouris
- Molecular Genetics Thalassaemia DepartmentThe Cyprus Institute of Neurology and GeneticsNicosiaCyprus,Cyprus School of Molecular MedicineNicosiaCyprus
| | - Coralea Stephanou
- Molecular Genetics Thalassaemia DepartmentThe Cyprus Institute of Neurology and GeneticsNicosiaCyprus
| | - Carsten W. Lederer
- Molecular Genetics Thalassaemia DepartmentThe Cyprus Institute of Neurology and GeneticsNicosiaCyprus,Cyprus School of Molecular MedicineNicosiaCyprus
| | - Joanne Traeger‐Synodinos
- Laboratory of Medical Genetics, St. Sophia's Children's HospitalNational and Kapodistrian University of AthensAthensGreece
| | - Celeste Bento
- Department of HaematologyCentro Hospitalar e Universitário de CoimbraCoimbraPortugal
| | - Cornelis L. Harteveld
- Department of Clinical Genetics/LDGALeiden University Medical CenterLeidenNetherlands
| | - Eirini Fylaktou
- Laboratory of Medical Genetics, St. Sophia's Children's HospitalNational and Kapodistrian University of AthensAthensGreece
| | - Tamara T. Koopmann
- Department of Clinical Genetics/LDGALeiden University Medical CenterLeidenNetherlands
| | | | - Kyriaki Michailidou
- Cyprus School of Molecular MedicineNicosiaCyprus,Biostatistics UnitThe Cyprus Institute of Neurology and GeneticsNicosiaCyprus
| | - Landry E. Nfonsam
- Hamilton Regional Laboratory Medicine ProgramHamilton Health SciencesHamiltonCanada,Department of Pathology and Molecular MedicineMcMaster UniversityHamiltonCanada
| | - John S. Waye
- Hamilton Regional Laboratory Medicine ProgramHamilton Health SciencesHamiltonCanada,Department of Pathology and Molecular MedicineMcMaster UniversityHamiltonCanada
| | | | - Marina Kleanthous
- Molecular Genetics Thalassaemia DepartmentThe Cyprus Institute of Neurology and GeneticsNicosiaCyprus,Cyprus School of Molecular MedicineNicosiaCyprus
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Pesce MM, Atkinson MM, Sridhar V, Edwards EG. Consideration of Splenectomy in Unstable Hemoglobinopathy: A Case Report of Hb Hammersmith ( HBB: c.128T>C). Hemoglobin 2022; 46:197-200. [PMID: 35762361 DOI: 10.1080/03630269.2022.2072318] [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] [Indexed: 11/04/2022]
Abstract
A 5-year-old female has been diagnosed with Hb Hammersmith (HBB: c.128T>C) and has required three blood transfusions thus far, with hemoglobin (Hb) levels dropping as low as 5.4 g/dL. An elective splenectomy is now being considered in order to reduce hemolysis and the need for transfusions. Of 18 previously reported cases of Hb Hammersmith, eight patients have reportedly undergone splenectomy, with only four of those studies reporting clinical improvement. Therefore, the role of splenectomy in unstable hemoglobinopathies remains unclear, but seems to be a promising option in Hb Hammersmith.
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Affiliation(s)
| | - Mandy M Atkinson
- Department of Pediatric Hematology/Oncology, Carilion Roanoke Memorial Hospital, Roanoke, VA, USA
| | | | - Erwood G Edwards
- Department of Pediatric Hematology/Oncology, Carilion Roanoke Memorial Hospital, Roanoke, VA, USA
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38
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Yousef AA, Shash HA, Almajid AN, Binammar AA, Almusabeh HA, Alshaqaq HM, Al-Qahtani MH, Albuali WH. Predictors of Recurrent Acute Chest Syndrome in Pediatric Sickle Cell Disease: A Retrospective Case-Control Study. Children (Basel) 2022; 9. [PMID: 35740831 DOI: 10.3390/children9060894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/18/2022] [Accepted: 06/12/2022] [Indexed: 11/17/2022]
Abstract
Acute chest syndrome (ACS) is a common cause of death in sickle cell disease (SCD) patients. Multiple studies investigated the risk factors of developing ACS; however, predictors of recurrent ACS episodes have not been thoroughly investigated. We aim to examine the clinical and laboratory predictors of recurrent ACS in pediatric patients with SCD. A retrospective case-control study included pediatric patients with SCD (˂14 years) admitted with ACS or developed ACS during admission for another indication. Patients were classified into recurrent ACS episodes (≥2 episodes) and a single ACS episode groups. Ninety-one ACS episodes (42 patients) were included, with a mean age at diagnosis of 7.18 ± 3.38 years. Twenty-two (52.4%) patients were male, and twenty-five (59.5%) patients had recurrent ACS. Younger age at first ACS was significantly associated with recurrence (p = 0.003), with an optimal cutoff at 7.5 years (area under the receiver operating characteristic curve [AUROC] = 0.833; p < 0.001). Higher SCD-related hospitalizations were significantly associated with recurrence (p = 0.038). Higher mean values of baseline white blood count (WBC) (p = 0.009), mean corpuscular volume (MCV) (p = 0.011), and reticulocyte (p = 0.036) were significantly associated with recurrence. Contrarily, lower baseline hematocrit values (p = 0.016) were significantly associated with recurrence. The ACS frequencies were significantly lower after hydroxyurea (p = 0.021). The odds of ACS recurrence increased with a positive C-reactive protein (CRP) at admission (p = 0.006). In conclusion, several baseline and admission laboratory data showed significant associations with recurrence. Hydroxyurea therapy demonstrated reduced ACS episodes.
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Maharaj S, Chang S. Procalcitonin as a diagnostic marker for infection in sickle cell disease. Expert Rev Hematol 2022; 15:559-564. [PMID: 35579470 DOI: 10.1080/17474086.2022.2079490] [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] [Indexed: 11/04/2022]
Abstract
Background: Patients with sickle cell disease (SCD) are at increased risk of infection. Fever often occurs with vaso-occlusive crisis (VOC), posing a diagnostic challenge in SCD. Procalcitonin (PCT) is an infectious biomarker validated in the general population but with limited data on use in SCD.Methods: We performed a retrospective single-center study (n=145) with primary objective of assessing ability of PCT to differentiate infection from VOC in SCD presenting with fever. Subgroups included confirmed bacterial infection (CBI), suspected bacterial infection, viral infection and VOC. A secondary objective examined association of PCT with acute chest syndrome. Clinical characteristics and data were collected and analyzed to assess diagnostic performance of PCT and associated variables.Results: The majority of patients were male with HbSS genotype, age ranging 18-73 years and mean of 34 years. Of the cohort, 16% had CBI and 8% had viral infection. PCT was able to discriminate CBI from viral infection [AUC=0.89 (95%CI, 0.78-0.99)] and VOC [AUC=0.87 (95%CI, 0.78-0.97)]. PCT had association with ACS but poor diagnostic performance [AUC=0.69 (95% CI, 0.54-0.84)].Conclusion: PCT has utility in distinguishing confirmed bacterial infection from VOC or viral infection and is a promising biomarker when investigating fever in SCD.
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Affiliation(s)
- Satish Maharaj
- Department of Internal Medicine, University of Louisville, Louisville, KY, USA
| | - Simone Chang
- Department of Hematology & Oncology, University of Louisville, Louisville, KY, USA
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40
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Khamphikham P, Sakkhachornphop S, Pongsatha S, Pornprasert S. Strong Positive Dichlorophenolindophenol Precipitation Suggests Hb Dhonburi (or Hb Neapolis) ( HBB: c.380T>G) Inheritance in a Couple at Risk for Severe β-Thalassemia. Hemoglobin 2022; 46:184-186. [PMID: 35543019 DOI: 10.1080/03630269.2022.2069033] [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] [Indexed: 11/04/2022]
Abstract
Hb Dhonburi (also known as Hb Neapolis) (HBB: c.380T>G) is an unstable hemoglobin (Hb) variant that cannot be detected by high performance liquid chromatography (HPLC) or capillary electrophoresis (CE) in routine laboratory diagnosis. This could lead to prenatal misdiagnosis unless a molecular analysis is applied. Here, we report a Thai couple with a positive result for the dichlorophenolindophenol precipitation (DCIP) screening test. After routine laboratory investigation, the female was diagnosed with heterozygous Hb E (HBB: c.79G>A) during pregnancy; however, the male, whose case we present herein, was suspected to carry a rare heterozygous β-thalassemia (β-thal). Therefore, they were designated as a couple at-risk for having a fetus with a serious thalassemia genotype: compound heterozygosity for Hb E with β-thal (Hb E/β-thal). Based on the result of the DCIP test, his DNA was sequenced for a causative mutation and revealed heterozygosity for a rare Hb variant, Hb Dhonburi. Theoretically, this couple was not at risk for Hb E/β-thal. Furthermore, this case demonstrates for the first time that in addition to a common Hb variant, i.e. Hb E, Hb Dhonburi (Hb Neapolis) also gives positive DCIP results, even in the heterozygous state.
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Affiliation(s)
- Pinyaphat Khamphikham
- Department of Medical Technology, Division of Clinical Microscopy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Supachai Sakkhachornphop
- Center for Molecular and Cell Biology, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Saipin Pongsatha
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sakorn Pornprasert
- Department of Medical Technology, Division of Clinical Microscopy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
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Abstract
India bears a huge burden of hemoglobinopathies, and the most prevalent is thalassemia. The different types of thalassemia include minor, major and intermedia, based on the α/β-globin chain inequality. This review aimed to understand the current prevalence of thalassemia in different regions of India and communities affected by it, along with the management of β-thalassemia major (β-TM) and β-thalassemia (β-thal) minor patients. A comprehensive electronic search for relevant articles was conducted using two databases, i.e. PubMed and Science Direct. Articles published in English from India between January 2009 and September 2021 were included. Studies from other countries, genetic and molecular characterization studies, and articles published in other languages were excluded. The prevalence of β-thal trait in Central India ranged between 1.4 and 3.4%, while 0.94% β-TM was reported among the patients with anemia. In South India, the prevalence of β-thal trait was between 8.50 and 37.90% and β-TM was reported to be between 2.30 and 7.47%. Northern and Western Indian states had a higher thalassemic burden. In Eastern India, tribal populations had a higher prevalence of β-thal trait (0.00-30.50%), β-TM (0.36-13.20%) and other hemoglobinopathies [Hb E (HBB: c.79G>A)/β-thal] (0.04-15.45%) than nontribal populations. Additionally, scheduled castes, scheduled tribes and other backward classes of low socioeconomic status and low literacy rates were affected by β-thal. Almost all Indian states reported β-thal; however, it is mostly concentrated in eastern and western parts of the country. Well-integrated strategies and effective implementation are needed at State and National levels to minimize the burden of β-thal.
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Affiliation(s)
- Surabhi S Yadav
- Nutrition and Dietetics Programme, Symbiosis Institute of Health Sciences (SIHS), Symbiosis International (Deemed University), Pune, India
| | - Pooja Panchal
- Nutrition and Dietetics Programme, Symbiosis Institute of Health Sciences (SIHS), Symbiosis International (Deemed University), Pune, India
| | - Kavitha C Menon
- Nutrition and Dietetics Programme, Symbiosis Institute of Health Sciences (SIHS), Symbiosis International (Deemed University), Pune, India
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Truttmann R, Schmidt A, Hartmann B, Rusch S, Mendez A. Description of Hb Évora ( HBA2: c.106T>C) on an Unexpected Allele in a Swiss Family. Hemoglobin 2022; 45:314-317. [PMID: 35114882 DOI: 10.1080/03630269.2022.2034643] [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] [Indexed: 10/19/2022]
Abstract
α-Thalassemia (α-thal) is caused by DNA deletions or point mutations in the genes coding for the α-globin chains and can lead to hemolytic anemia in its carriers. If only one of the four α genes is affected, the mutation is mostly discovered by chance, as the carriers are asymptomatic. Hb Évora (HBA2: c.106T>C) is an Hb variant that leads to such an α-thal trait (αTα/αα) and thus, to mild microcytic hypochromic anemia. The mutation was first reported in 2001 and named Hb Évora in 2007 (based on the geographic origin of one of the studied families). It was found in four unrelated families originating from Portugal and the Philippines. We now report the discovery of Hb Évora not only in a proband with no known ancestors from either country, but also on an unexpected allele. Subsequently, her close relatives were studied, revealing the same mutation in her brother. No clear correlation between phenotype and genotype was observed.
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Affiliation(s)
- Rahel Truttmann
- Clinic of Haematology and Oncology, Municipal Hospital Zürich Triemli, Zürich, Switzerland
| | - Adrian Schmidt
- Clinic of Haematology and Oncology, Municipal Hospital Zürich Triemli, Zürich, Switzerland
| | - Britta Hartmann
- Centre for Laboratory Medicine, Haematology, Cantonal Hospital, Aarau, Switzerland
| | - Sebastian Rusch
- Centre for Laboratory Medicine, Haematology, Cantonal Hospital, Aarau, Switzerland
| | - Adriana Mendez
- Centre for Laboratory Medicine, Haematology, Cantonal Hospital, Aarau, Switzerland
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Malagù M, Marchini F, Fiorio A, Sirugo P, Clò S, Mari E, Gamberini MR, Rapezzi C, Bertini M. Atrial Fibrillation in β-Thalassemia: Overview of Mechanism, Significance and Clinical Management. Biology (Basel) 2022; 11:biology11010148. [PMID: 35053146 PMCID: PMC8772694 DOI: 10.3390/biology11010148] [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] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 05/05/2023]
Abstract
Thalassemia is an inherited blood disorder with worldwide distribution. Transfusion and chelation therapy have radically improved the prognosis of β-thalassemic patients in the developed world, but this has led to the development of new chronic cardiac complications like atrial fibrillation (AF). Prevalence of AF in patients with β-thalassemia is higher than in the general population, ranging from 2 to 33%. Studies are lacking, and the little evidence available comes from a small number of observational studies. The pathophysiology is not well understood but, while iron overload seems to be the principal mechanism, AF could develop even in the absence of iron deposition. Furthermore, the clinical presentation is mainly paroxysmal, and patients are highly symptomatic. The underlying disease, the pathophysiology, and the clinical presentation require a different management of AF in β-thalassemia than in the general population. Rhythm control should be preferred over rate control, and the most important antiarrhythmic therapy is represented by chelation drugs. Thromboembolic risk is high, but the available risk scores are not validated in β-thalassemia, and the choice of anticoagulation therapy should be considered early. The main purpose of this review is to summarize the actual knowledge about AF in β-thalassemia, with a specific focus on the clinical management of these complex patients.
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Affiliation(s)
- Michele Malagù
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy; (F.M.); (A.F.); (P.S.); (S.C.); (C.R.); (M.B.)
- Correspondence: ; Tel.: +39-532-236269
| | - Federico Marchini
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy; (F.M.); (A.F.); (P.S.); (S.C.); (C.R.); (M.B.)
| | - Alessio Fiorio
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy; (F.M.); (A.F.); (P.S.); (S.C.); (C.R.); (M.B.)
| | - Paolo Sirugo
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy; (F.M.); (A.F.); (P.S.); (S.C.); (C.R.); (M.B.)
| | - Stefano Clò
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy; (F.M.); (A.F.); (P.S.); (S.C.); (C.R.); (M.B.)
| | - Elisa Mari
- Day Hospital Thalassemia and Hemoglobinopathies, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy; (E.M.); (M.R.G.)
| | - Maria Rita Gamberini
- Day Hospital Thalassemia and Hemoglobinopathies, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy; (E.M.); (M.R.G.)
| | - Claudio Rapezzi
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy; (F.M.); (A.F.); (P.S.); (S.C.); (C.R.); (M.B.)
| | - Matteo Bertini
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy; (F.M.); (A.F.); (P.S.); (S.C.); (C.R.); (M.B.)
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Gao W, Jin Y, Wang M, Huang Y, Tang H. Case Report: Abnormally Low Glycosylated Hemoglobin A1c Caused by Clinically Silent Rare β-Thalassemia in a Tujia Chinese Woman. Front Endocrinol (Lausanne) 2022; 13:878680. [PMID: 35600576 PMCID: PMC9114733 DOI: 10.3389/fendo.2022.878680] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Glycosylated hemoglobin A1c (HbA1c) is an important means of monitoring blood glucose and diagnosing diabetes. High-performance liquid chromatography (HPLC) is the most widely used method to detect HbA1c in clinical practice. However, the results of HbA1c by HPLC are susceptible to hemoglobinopathy. Here, we report a case of discordantly low HbA1c with an abnormal chromatogram caused by rare β-thalassemia. CASE DESCRIPTION A 36-year-old Tujia Chinese woman presented with an abnormally low HbA1c level of 3.4% by HPLC in a health check-up. The chromatogram of HbA1c showed an abnormal peak. Fasting blood glucose, routine blood tests and serum bilirubin were normal. Her body mass index was 27.86 kg/m2. Hemoglobin electrophoresis showed low hemoglobin A and abnormal hemoglobin β-chain variants. The thalassemia gene test suggested a rare type of β-thalassemia (gene sequencing HBB: c.170G>A, Hb J-Bangkok (GGC->GAC at codon 56) in a beta heterozygous mutation). Glycated albumin (GA) was slightly increased. Oral glucose tolerance tests (OGTT) and insulin release tests indicated impaired glucose tolerance and insulin resistance. The hematologist advised follow-up visits. The endocrinologist recommended that the patient adopt lifestyle intervention. Three months later, GA returned to normal, and impaired glucose tolerance and insulin resistance improved. CONCLUSIONS Clinically silent β-thalassemia may lead to low HbA1c values and abnormal chromatograms by HPLC. In these circumstances, differential diagnosis is important. Checking the chromatogram may be helpful in interpreting HbA1c as well as identifying hemoglobinopathy. Further tests, such as GA, OGTT, hemoglobin electrophoresis and genetic tests, are needed for differential diagnosis.
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Affiliation(s)
- Wei Gao
- Health Management Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yanwen Jin
- Biliary Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Minjin Wang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Huang
- Health Management Center, West China Hospital, Sichuan University, Chengdu, China
| | - Huairong Tang
- Health Management Center, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Huairong Tang,
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Chowdhury MA, Sultana R, Das D. Thalassemia in Asia 2021 Overview of Thalassemia and Hemoglobinopathies in Bangladesh. Hemoglobin 2022; 46:7-9. [PMID: 35950585 DOI: 10.1080/03630269.2021.2008957] [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] [Indexed: 11/04/2022]
Abstract
Bangladesh is a country with a population of 160 million with a gross national income per capita of US$1580.00. The major health problems in Bangladesh include acute respiratory infection, pneumonia, dengue fever, malaria and water-borne diseases. The health care system in Bangladesh is divided into primary secondary and tertiary levels, with each level having their own breakdown of available hospital beds and other treatment facilities. Thalassemia is a major health problem in Bangladesh. There are two types of thalassemia in Bangladesh: β-thalassemia (β-thal) and Hb E (HBB: c.79G>A)/β-thal, with the prevalence rate of β-thal trait being 4.1% and Hb E trait 6.1%. This study discusses spectrum types of thalassemia and hemoglobinopathies in Bangladesh and the types of carrier detection. The distribution of common mutations of thalassemia are also discussed and the distribution frequencies of genotypes and alleles of β-thal and Hb E patients are also compared. Additionally, we also conducted a study of the spectrum of thalassemia using high performance liquid chromatography (HPLC) of the tribal populations and analyzed the findings in our discussion. The results of these studies show that the phenotypic and genotypic presentation in Bangladesh is highly diverse. To properly understand this, we have to conduct an epidemiological survey of the population. Furthermore, there also has to be improvement on the awareness of thalassemia among the population to properly equip themselves to survive this disease.
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Affiliation(s)
- Mahmood A Chowdhury
- Department of Paediatrics, Chattogram Maa-O-Shishu Hospital Medical College, Agrabad, Chattogram, Bangladesh
| | - Razia Sultana
- Department of Paediatrics, Chattogram Maa-O-Shishu Hospital Medical College, Agrabad, Chattogram, Bangladesh
| | - Dhananjoy Das
- Department of Paediatrics, Chattogram Maa-O-Shishu Hospital Medical College, Agrabad, Chattogram, Bangladesh
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Han J, Tam K, Tam C, Hollis RP, Kohn DB. Improved lentiviral vector titers from a multi-gene knockout packaging line. Mol Ther Oncolytics 2021; 23:582-592. [PMID: 34938858 PMCID: PMC8660686 DOI: 10.1016/j.omto.2021.11.012] [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] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/18/2021] [Indexed: 01/01/2023] Open
Abstract
Lentiviral vectors (LVs) are robust delivery vehicles for gene therapy as they can efficiently integrate transgenes into host cell genomes. However, LVs with lengthy or complex expression cassettes typically are produced at low titers and have reduced gene transfer capacity, creating barriers for clinical and commercial applications. Modifications of the packaging cell line and methods may be able to produce complex vectors at higher titer and infectivity and may improve production of many different LVs. In this study, we identified two host restriction factors in HEK293T packaging cells that impeded LV production, 2'-5'-oligoadenylate synthetase 1 (OAS1) and low-density lipoprotein receptor (LDLR). Knocking out these two genes separately led to ∼2-fold increases in viral titer. We created a monoclonal cell line, CRISPRed HEK293T to Disrupt Antiviral Response (CHEDAR), by successively knocking out OAS1, LDLR, and PKR, a previously identified factor impeding LV titers. Packaging in CHEDAR yielded ∼7-fold increases in physical particles, full-length vector RNA, and vector titers. In addition, overexpressing transcription elongation factors, SPT4 and SPT5, during packaging improved the production of full-length vector RNA, thereby increasing titers by ∼2-fold. Packaging in CHEDAR with over-expression of SPT4 and SPT5 led to ∼11-fold increases of titers. These approaches improved the production of a variety of LVs, especially vectors with low titers or with internal promoters in the reverse orientation, and may be beneficial for multiple gene therapy applications.
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Affiliation(s)
- Jiaying Han
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Kevin Tam
- Department of Molecular, Cell, and Developmental Biology, University of California, Los Angeles, CA 90095, USA
| | - Curtis Tam
- Department of Molecular, Cell, and Developmental Biology, University of California, Los Angeles, CA 90095, USA
| | - Roger P. Hollis
- Department of Microbiology, Immunology & Molecular Genetics, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Donald B. Kohn
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
- Department of Microbiology, Immunology & Molecular Genetics, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
- The Eli & Edythe Broad Center of Regenerative Medicine & Stem Cell Research, University of California, Los Angeles, CA 90095, USA
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA 90095, USA
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47
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Göttgens EL, Baks K, Harteveld CL, Goossens K, van Gammeren AJ. Cyanosis, hemolysis, decreased HbA1c and abnormal co-oximetry in a patient with hemoglobin M Saskatoon [HBB:c.190C > T p.His64Tyr]. Hematology 2021; 26:914-918. [PMID: 34789072 DOI: 10.1080/16078454.2021.1999048] [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] [Indexed: 10/19/2022] Open
Abstract
We describe a first Dutch case of Hb M Saskatoon (HBB:c.190C > T p.His64Tyr) in a 47-year-old female Dutch patient who presented with cyanosis, hemolysis, and abnormal co-oximetry. A mean corpuscular volume (MCV) of 105 fL caused by reticulocytosis (160 × 109/L) and low red blood cell count (3.6 × 1012/L) suggested an increased erythrocyte turnover. An HPLC glyco-globin analysis revealed a decreased HbA1c fraction of 12.3 mmol/mmol, HbA0 of 93.3% and an additional unidentified fraction at 1.2 min. DNA sequencing revealed a missense mutation in the HBB gene, (HBB:c.190C > T p.His64Tyr), known as Hb M Saskatoon, a variant which has been previously identified as an unstable hemoglobin variant leading to methemoglobinemia and anemia. In this report, we describe the clinical and remarkable laboratory aspects of our patient with Hb M Saskatoon, and the consequences for treatment and drug use.
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Affiliation(s)
- Eva-Leonne Göttgens
- Result Laboratory for Clinical Chemistry and Hematology, Amphia Hospital, Breda, The Netherlands
| | - Kristian Baks
- Department of Internal Medicine, Amphia Hospital, Breda, The Netherlands
| | - Cornelis L Harteveld
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Kristel Goossens
- Department of Internal Medicine, Amphia Hospital, Breda, The Netherlands
| | - Adriaan J van Gammeren
- Result Laboratory for Clinical Chemistry and Hematology, Amphia Hospital, Breda, The Netherlands
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Grimholt RM, Fjeld B, Klingenberg O. Hemoglobinopathy gone astray-three novel forms of α-thalassemia in Norwegian patients characterized by quantitative real-time PCR and DNA sequencing. Scand J Clin Lab Invest 2021; 81:670-678. [PMID: 34791962 DOI: 10.1080/00365513.2021.2004218] [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] [Indexed: 10/19/2022]
Abstract
α-thalassemia is one of the most common monogenic diseases worldwide and is caused by reduced or absent synthesis of α-globin chains, most commonly due to deletions of one or more of the α-globin genes. α-thalassemia occurs with high frequency in tropical and subtropical regions of the world and are very rarely found in the indigenous Scandinavian population. Here, we describe four rare forms of α-thalassemia out of which three are novel, found in together 20 patients of Norwegian origin. The study patients were diagnosed during routine hemoglobinopathy evaluation carried out at the Department of Medical Biochemistry, Oslo University Hospital, Norway. The patients were selected for their thalassemic phenotype, despite Norway as country of origin. All samples went through standard hemoglobinopathy evaluation. DNA sequencing and copy number variation (CNV) analysis using quantitative real-time polymerase chain reaction (qPCR) was applied to detect sequence variants and uncommon deletions in the α-globin gene cluster, respectively. Deletion breakpoints were characterized using gap-PCR and DNA sequencing. DNA sequencing revealed a single nucleotide deletion in exon 3 of the HBA2 gene (NM_000517.4(HBA2):c.345del) and a novel deletion of 20 nucleotides in exon 2 of the HBA2 gene (NM_000517.4(HBA2):c.142_161del). qPCR CNV analysis detected two novel large deletions in the α-globin gene cluster, -(NOR) deletion covering both α-globin genes and (αα)Aurora Borealis affecting the regulatory region, leaving the downstream α-globin genes intact. Even though inherited globin gene disorders are extremely rare in indigenous Scandinavians, the possibility of a carrier state should not be ignored.
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Affiliation(s)
- Runa M Grimholt
- Department of Medical Biochemistry, Oslo University Hospital, Ullevaal, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Life Sciences and Health, Oslo Metropolitan University, Oslo, Norway
| | - Bente Fjeld
- Department of Medical Biochemistry, Oslo University Hospital, Ullevaal, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Olav Klingenberg
- Department of Medical Biochemistry, Oslo University Hospital, Ullevaal, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
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Ma Z, Fan S, Liu J, Liu Y, Guo Y, Huang W. Molecular characterization of hemoglobinopathies and thalassemias in Northern Guangdong Province, China. Medicine (Baltimore) 2021; 100:e27713. [PMID: 34766575 PMCID: PMC10545308 DOI: 10.1097/md.0000000000027713] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/06/2021] [Accepted: 10/19/2021] [Indexed: 02/05/2023] Open
Abstract
ABSTRACT To detect the molecular characterization of hemoglobinopathies and thalassemias in Northern Guangdong Province of China.We recruited 10,285 subjects who were screened for hemoglobin (Hb) variants and thalassaemia genotypes in the outpatient department of Yuebei People's Hospital from January 2018 to December 2020. The subjects collected venous blood samples for blood cell parameter analysis and Hb electrophoresis analysis. When the average red blood cell volume is <82 fL, or the average red blood cell Hb is <27 pg, or HbA2 > 3.5%, or HbA2 < 2.5%, or HbF > 2.0%, the screening is positive if one of them is satisfied. All subjects who were screened positive were tested for the thalassaemia gene by gap-polymerase chain reaction, PCR-based reverse dot blot, and DNA sequencing.Among all subjects screened, the overall prevalence of hemoglobinopathies and thalassemias were 0.46% (47/10,285) and 21.02% (2162/10,285) in Northern Guangdong Province. We found that Hb Q-Thailand is the most common, and other types of hemoglobinopathies are followed by Hb E, Hb New York, Hb G-Chinese, Hb G-Coushatta, Hb J-Bangkok, Hb J-Broussais, Hb Ottawa, and Hb G-Taipei. We identified 1340 cases (13.03%) of α-thalassemia, mainly includes --SEA deletion (71.64%), -α3.7 deletion (12.01%), -α4.2 deletion (4.78%). And identified 652 cases (6.34%) of β-thalassemia, the most prevalent being CD 41/42(-TTCT) (35.89%), IVS-II-654 (C > T) (33.44%), CD 17 (A > T) (10.28%) and -28(A > G) (9.66%). Furthermore, there are 170 cases (1.65%) of α combined β thalassaemia. In addition, we found a rare case with -80 (T > A) of β-thalassemia. The results of this study found a high prevalence of hemoglobinopathies and thalassemias in Northern Guangdong Province, China. There were some differences molecular characterizations of thalassemia in different areas of China.Our results enriched the related information of hemoglobinopathies and thalassemias in the region, which provided valuable references for the prevention and control of thalassemia.
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Affiliation(s)
- Zhanzhong Ma
- Clinical Laboratory, Yuebei People's Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong Province, China
- Biobank of Yuebei People's Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong Province, China
| | - Shushu Fan
- Reproductive Medicine Center, Yuebei People's Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong Province, China
| | - Jun Liu
- Clinical Laboratory, Yuebei People's Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong Province, China
| | - Yulan Liu
- Clinical Laboratory, Yuebei People's Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong Province, China
| | - Yanle Guo
- Clinical Laboratory, Yuebei People's Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong Province, China
| | - Wenbo Huang
- Reproductive Medicine Center, Yuebei People's Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong Province, China
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50
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Zhuang J, Zhang N, Wang Y, Zhang H, Zheng Y, Jiang Y, Xie Y, Chen D. Molecular Characterization Analysis of Thalassemia and Hemoglobinopathy in Quanzhou, Southeast China: A Large-Scale Retrospective Study. Front Genet 2021; 12:727233. [PMID: 34659349 PMCID: PMC8514685 DOI: 10.3389/fgene.2021.727233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 06/18/2021] [Accepted: 08/20/2021] [Indexed: 01/23/2023] Open
Abstract
Background: There are limited reports available on investigations into the molecular spectrum of thalassemia and hemoglobinopathy in Fujian province, Southeast China. Here, we aim to reveal the spectrum of the thalassemia mutation and hemoglobinopathy in Quanzhou prefecture, Fujian province. Methods: We collected data from a total of 17,407 subjects with the thalassemia trait in Quanzhou prefecture. Gap-PCR, DNA reverse dot blot hybridization, and DNA sequencing were utilized for common and rare thalassemia gene testing. Results: In our study, we identified 7,085 subjects who were carrying thalassemia mutations, representing a detection rate of 40.70% (7,085/17,407). Among them, 13 different α-thalassemia gene mutations were detected, with the most common mutation being –SEA (69.01%), followed by –α3.7 (21.34%) and –α4.2 (3.96%). We also discovered 26 β-thalassemia gene mutations, with the mutations of IVS-II-654 (C > T) (36.28%) and CD41/42(–TCTT) (29.16%) being the most prevalent. Besides, a variety of rare thalassemia variants were identified. Among them, the –FIL, βMalay, βIVS–I–130, and βIVS–II–672 mutations were identified in Fujian province for the first time. Additionally, we detected 78 cases of hemoglobinopathies, of which Hb Owari was the first reported case in Fujian province and Hb Miyashiro was the first case identified in the Chinese population. Conclusion: Our study indicates that there is a diverse range of thalassemia mutations, and it also reveals the mutation spectrum of rare thalassemia and hemoglobinopathies in Quanzhou, Fujian province. It provides valuable data for the prevention and control of thalassemia in Southeast China.
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Affiliation(s)
- Jianlong Zhuang
- Prenatal Diagnosis Center, Quanzhou Women's and Children's Hospital, Quanzhou, China
| | - Na Zhang
- Prenatal Diagnosis Center, Quanzhou Women's and Children's Hospital, Quanzhou, China
| | - Yuanbai Wang
- Prenatal Diagnosis Center, Quanzhou Women's and Children's Hospital, Quanzhou, China
| | - Hegan Zhang
- Department of Gynecology, Quanzhou Women's and Children's Hospital, Quanzhou, China
| | - Yu Zheng
- Research and Development Department, Yaneng BIOscience (Shenzhen) Co. Ltd., Shenzhen, China
| | - Yuying Jiang
- Prenatal Diagnosis Center, Quanzhou Women's and Children's Hospital, Quanzhou, China
| | - Yingjun Xie
- Key Laboratory for Major Obstetric Diseases of Guangdong Province, Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Dongmei Chen
- Department of Neonatal Intensive Care Unit, Quanzhou Women's and Children's Hospital, Quanzhou, China
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