201. Molecular understanding of unusual HbE-β+-thalassemia with Hb phenotype similar to HbE heterozygote: simple and rapid differentiation using HbE levels.
- Author
-
Jomoui, Wittaya, Satthakarn, Surada, and Panyasai, Sitthichai
- Subjects
DNA analysis ,PHENOTYPES ,RECEIVER operating characteristic curves ,HYDROPS fetalis ,DNA sequencing ,HETEROZYGOSITY - Abstract
Low HbF expression in HbE-β
+ -thalassemia may lead to misdiagnosis of HbE heterozygosity. We aimed to characterize the β- and α-globin genes and the modifying factors related to HbF expression in patients with an Hb phenotype similar to that of HbE heterozygotes. Furthermore, screening tools for differentiating HbE-β+ -thalassemia from HbE heterozygotes have been investigated. A total of 2133 participants with HbE and HbA with varying HbF levels were recruited. Polymerase chain reaction-based DNA analysis and sequencing were performed to characterize β- and α-globin genes. DNA polymorphism at position −158 nt 5′ toG γ-globin was performed by XmnI restriction digestion. Receiver operating characteristic (ROC) curves were constructed using the area under the curve (AUC). Cutoff values of HbA2 , HbE, and HbF levels for the differentiation of HbE-β+ -thalassemia from HbE heterozygotes were determined. Five β+ -thalassemia mutations trans to βE -gene (β−87(C>A) , β−31(A>G) , β−28(A>G) , β19(A>G) , and β126(T>G) ) were identified in 79 patients. Among these, 54 presented with low HbF levels, and 25 presented with high HbF levels. ROC curve analysis revealed an excellent AUC of 1.000 (95% confidence interval:1.000–1.000) for HbE levels, and a cut-off point of ≥35.0% had 100.0% sensitivity, specificity, and Youden's index for differentiating HbE-β+ -thalassemia from HbE heterozygotes. The proportion of α-thalassemia mutations was 46.3 and 8.0% among HbE-β+ -thalassemia patients with low and high HbF levels, respectively. Two rare α-thalassemia mutations (Cap +14(C>G) and initiation codon (ATG>-TG)) of α2 -globin genes were identified. The genotype and allele of the polymorphism at −158 nt 5′ toG γ-globin was found to be negatively associated with HbF expression. HbE-β+ -thalassemia cannot be disregarded until appropriate DNA analysis is performed, and the detection of α-thalassemia mutations should always be performed under these conditions. An HbE level ≥35.0% may indicate screening of samples for DNA analysis for HbE-β+ -thalassemia diagnosis. HbE-β+ -thalassemia displays a wide range of HbF expression, which may lead to the misdiagnosis of HbE heterozygosity in patients whose Hb analysis shows HbE and HbA. α-Thalassemia may be a major factor associated with decreased secondary activation of HbF expression in the disease. HbE may be a potential indicator for effectively differentiating HbE-β+ -thalassemia from HbE heterozygotes. The high proportion and heterogeneity of α-thalassemia mutations found in patients with HbE-β+ -thalassemia evoke a complex thalassemia syndrome, requiring complete DNA analysis. [ABSTRACT FROM AUTHOR]- Published
- 2023
- Full Text
- View/download PDF