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Sudden monocular blindness associated with homozygous B-thalassemia in a young Liberian.

A 16-year old Liberian female presented with sudden monocular blindness. Physical examination and laboratory investigations were normal except that the patient had homozygous B-Thalassemia (HbA 58%, HbF 5% and HbA2 7.0%). Family study revealed that both parents had B-Thalassemia trait. We feel that the association of sudden monocular blindness with homozygous B-Thalassemia which has not been reported before, is not fortuitous but causal. It is therefore suggested that homozygous B-Thalassemia be added to the list of haemoglobinopathies (HbAS, SS and SC) that have been reported to cause blindness as complication.

Adolescent↗

Alpha thalassemia and the hematology of homozygous sickle cell disease in childhood.

alpha Thalassemia modifies the hematologic expression of homozygous sickle cell (SS) disease, resulting in increased total hemoglobin and HbA2 and decreased HbF, mean cell volume, reticulocytes, irreversibly sickled cells, and bilirubin levels. The age at which these changes develop in children with SS disease is unknown. Ascertainment of globin gene status in a large representative sample of children with SS disease has afforded an opportunity to study the hematologic indices in nine children homozygous for alpha thalassemia 2 (two-gene group), 90 children heterozygous for alpha thalassemia 2 (three-gene group), and 167 children with a normal alpha globin gene complement (four-gene group). The two-gene group had significantly lower mean cell volumes from birth, higher red cell counts from one month, lower reticulocytes from three months, and higher HbA2 levels from one year, as compared with the four-gene group. Children with three genes had intermediate indices but resembled more closely the four-gene group. Differences in total hemoglobin or in fetal hemoglobin between the groups were not apparent by eight years of age. The most characteristic differences of the two-gene group were the raised proportional HbA2 level and low mean cell volume, the latter having some predictive value for alpha thalassemia status at birth.

Age Factors↗

Beta zero-thalassemia in association with a gamma-globin gene quadruplication.

We have studied the hematology, hemoglobin composition, and globin gene arrangements in one young Turkish boy with a beta zero-thalassemia homozygosity and in 11 of his relatives. Evidence is presented that the chromosome with the beta zero-thalassemia determinant carries a gamma-globin gene quadruplication, perhaps in a -G gamma-G gamma-G gamma-A gamma-gene arrangement. The eight gamma-globin genes in this patient produced G gamma and A gamma chains in a 95 to 5 ratio, and nearly 99% of the patient's hemoglobin was of the fetal type. The clinical condition resembled that of a thalassemia intermedia. HbF levels in eight beta-thalassemia heterozygotes varied between 0.5 and 4.2% and the percentages of G gamma in this HbF averaged at 87% or 95%; this level is to some extent related to the haplotype of the normal chromosome. All subjects carried four alpha-globin genes; a new BglII polymorphism was observed within the psi alpha-globin gene.

Consanguinity↗

Laotian (delta beta) (0)-thalassemia: molecular characterization of a novel deletion associated with increased production of fetal hemoglobin.

We have identified and molecularly characterized a novel deletion in the beta-globin gene cluster that increases fetal hemoglobin (HbF) synthesis in a 24-year-old Laotian man who is heterozygous for this mutation. The patient is asymptomatic with a mild anemia, hypochromia, and microcytosis (Ht = 39%, MCH = 22.8 pg, MCV = 71 fl), normal levels of HbA2 (3.0%) and 11.5% HbF (G gamma A gamma ratio 60 to 40), with heterocellular distribution (52% F cells). Extensive restriction endonuclease mapping defined the 5' breakpoint within the IVS II of the delta-globin gene, between positions 775 to 781 very similar to the 5' breakpoint of the Sicilian delta beta-thalassemia. However, the 3' breakpoint was localized between two Pst I sites 4.7 kb 3' of the beta-globin gene, thus ending about 0.7 kb upstream from the 3' breakpoint of the Sicilian delta beta-thalassemia. This results in a 12.5 kb deletion of DNA. It is of interest that the 5' breakpoint of the deletion residues within an AT-rich region which has been proposed as a specific recognition signal for recombination events, while the 3' breakpoint lies within a cluster of L1 repetitive sequences (formerly known as Kpn I family repeats). The presence of the 3' breakpoints of several other deletions within this region of L1 repeats also suggests that such sequences might serve as hot spots for recombination and eventually lead to thalassemia deletions. The similarity of the 5' and 3' breakpoints of these delta beta-thalassemias underscores the putative regulatory role of the deleted and juxtaposed sequences on the expression of the gamma-globin genes in adult life.

Adult↗

Prospects for correction of thalassemia by genetic engineering.

The thalassemias are diverse genetic disorders characterized by abnormal synthesis rates of one or more proteins constituting hemoglobin (globin-chains). In the beta-thalassemias, genes encoding the beta-globin chain are intact but are abnormally transcribed or, less often, translated. In the alpha-thalassemias, genes encoding the alpha-globin chain are often deleted; abnormal transcription can also occur. The human beta- and alpha-globin genes were molecularly cloned. This review considers attempts to introduce these genes in mammalian cells by physical techniques such as chromosome transfer, transfection, fusion, micro-injection, electroporation and homologous recombination or by using DNA or RNA viruses, such as retroviruses. Currently, inefficient gene expression in host cells and the need for precise cognate regulation of globin gene expression are the major limitations to applying genetic engineering to thalassemia.

Gene Expression Regulation↗

A C----T substitution at nt--101 in a conserved DNA sequence of the promotor region of the beta-globin gene is associated with "silent" beta-thalassemia.

Sequence analyses and dot-blot analyses with synthetic oligonucleotide probes have identified eight individuals in three Turkish families and one Bulgarian family with one chromosome having a C----T mutation at nucleotide position--101 relative to the Cap site of the beta-globin gene. This nucleotide is part of one of the conserved blocks of nucleotides within the promoter region; in vitro expression analyses with the chloramphenicol acetyltransferase system showed that this substitution will decrease the effectiveness of transcription. Five subjects had a thalassemia intermedia due to the additional presence of a known classical high hemoglobin (Hb) A2 beta-thalassemia mutation on the second chromosome; their hematologic condition was relatively mild. The three persons with a heterozygosity for the--101 C----T mutation had normal hematologic data without microcytosis but with high-normal levels of Hb A2 and a mild imbalance in chain synthesis. The newly discovered mutation is considered one of the silent types of beta-thalassemia. It is relatively rare because it was absent among several hundred normal and beta-thalassemia chromosomes.

Base Sequence↗

A study of membrane protein defects and alpha hemoglobin chains of red blood cells in human beta thalassemia.

The soluble pool of alpha hemoglobin chains present in blood or bone marrow cells was measured with a new affinity method using a specific probe, beta A hemoglobin chain labeled with [3H]N-ethylmaleimide. This pool of soluble alpha chains was 0.067 +/- 0.017% of hemoglobin in blood of normal adult, 0.11 +/- 0.03% in heterozygous beta thalassemia and ranged from 0.26 to 1.30% in homozygous beta thalassemia intermedia. This elevated pool of soluble alpha chains observed in human beta thalassemia intermedia decreased 33-fold from a value of 10% of total hemoglobin in bone marrow cells to 0.3% in the most dense red blood cells. The amount of insoluble alpha chains was measured by using the polyacrylamide gel electrophoresis in urea and Triton X-100. In beta thalassemia intermedia the amount of insoluble alpha chains was correlated with the decreased spectrin content of red cell membrane and was associated with a decrease in ankyrin and with other abnormalities of the electrophoretic pattern of membrane proteins. The loss and topology of the reactive thiol groups of membrane proteins was determined by using [3H]N-ethylmaleimide added to membrane ghosts prior to urea and Triton X-100 electrophoresis. Spectrin and ankyrin were the major proteins with the most important decrease of thiol groups.

Erythrocyte Membrane↗

The molecular basis of alpha thalassemia in India. Its interaction with the sickle cell gene.

The alpha globin genotype of a total of 282 Indians from Orissa state has been analyzed. The overall alpha thalassemia gene frequency is 0.29, most frequently caused by the -alpha 3.7 and -alpha 4.2 deletions. In one family a novel -alpha 3.5 deletion removing the alpha 1 globin gene with some of its flanking sequences has been found, suggesting further sequence homology of the alpha globin gene cluster 3' to the alpha 1 globin gene. Patients with sickle cell disease and alpha thalassemia had higher hemoglobin (Hb) levels, RBC counts, and Hb A2 levels, and lower reticulocyte counts, MCV, MCH, and Hb F levels than those with a normal alpha genotype. The frequency of splenomegaly was not influenced by the alpha globin genotype. A higher prevalence of alpha thalassemia was found in patients greater than or equal to 10 years of age than in the younger group, suggesting a possible advantageous effect of alpha thalassemia on the survival of patients with sickle cell disease.

Age Factors↗

The spectrum of beta-thalassemia genes in China and Southeast Asia.

To make possible prenatal diagnosis of beta-thalassemia in China and Southeast Asia by direct detection of mutant beta-globin genes, we have determined the spectrum of mutations producing the disorder in this region of the world. Seventy-eight beta-thalassemia genes from Chinese and Southeast Asians were randomly obtained, and the relevant mutation was characterized in 76 (98%) of them. Seven different point mutations were found among the 78 genes studied. Of these seven beta-thalassemia alleles, two constitute 62%, and two others account for 29% of the total. Since only four alleles make up 91% of the mutant genes, prenatal diagnosis of beta-thalassemia in China and Southeast Asia should be feasible by simplified techniques for direct detection of point mutations.

Asia, Southeastern↗

[Characteristics of the expression of globin genes in blood cells of patients with homozygotic beta-thalassemia from Tadzhikistan].

The synthesis of globin protein in blood reticulocytes of patients from Tajikistan suffering from homozygous beta-thalassemia was studied. Beta-thalassemia has been revealed in all cases, with synthesis of beta-globin being retained though essentially reduced. It was shown that, unlike homozygous beta+-thalassemia of other populations, beta +thalassemia with sharp inhibition of the beta-globin protein synthesis is most representative for the region (alpha/beta greater than 10).

Adolescent↗

Identification of a beta-thalassemia mutation associated with a novel haplotype of RFLPs.

The study of the molecular defects that result in beta-thalassemia in Mediterraneans has uncovered a large number of unique mutations. This information is already being utilized for prenatal diagnosis of pregnancies at risk. Here, we report the definitive identification, by molecular cloning, of the beta-thalassemia mutation associated with a Mediterranean chromosome bearing a novel haplotype of restriction fragment length polymorphisms (RFLPs) in the beta gene cluster that has been previously designated as haplotype X. The thalassemia mutation was identified as a T----C base substitution at IVS-1 position 6, a mutation previously described in association with haplotype VI. We describe the use of the restriction enzyme SfaNI for the detection of this mutation and point out a possible pitfall that should be avoided if such an approach is used for the detection of this mutation, which appears to be a common cause of mild beta+-thalassemia in some populations.

Alleles↗

Types of alpha+ thalassemia in Southeast Asia refugees.

We have determined alpha+ deletional thalassemia among 143 Southeast Asia refugees (Cambodians, Laotians, and Vietnameses). Gene frequency of alpha+ deletional thalassemia in Vietnameses (0.035) was found lower than in Cambodians and Laotians (0.11). Bam H1 and Bg1 II analysis indicated that both rightward and leftward thalassemias are encountered, the -alpha 3,7 form is being by far more frequent than the -alpha 4.2 one. Only type I cross-over was found by Apa I digestion on -alpha 3.7 chromosomes. The Rsa I polymorphism, 5' to Z alpha 2 block, is associated with -alpha 3.7 type I haplotype and the site is present in 12 out of 23 chromosomes. All these data suggest at least three origins of alpha+-thalassemia in Cambodia and Laos.

Asia, Southeastern↗

Thalassemia syndromes. Recent advances.

Laboratory and clinical investigators in the past several years have provided many advancements in the understanding of the thalassemia syndromes and in the care of affected patients. The diversity of genetic defects causing thalassemia has been extensively explored, with major benefits to our knowledge of normal globin gene function and of the consequences of specific mutations. In addition, the use of molecular biology methods in these studies has provided major advances in population genetics, gene transfer, and prenatal diagnosis of thalassemia. In the clinical area, guidelines for transfusion, splenectomy, prevention of postsplenectomy infection, and effective iron chelation have been considerably improved, and bone marrow transplantation is now available as an alternative means of treatment. Despite these advances, a great deal remains to be done in the areas of understanding the developmental regulation of globin gene expression, effective gene transfer, oral chelation therapy, safer blood products, and other important areas that will benefit patients afflicted with thalassemia.

Bone Marrow Transplantation↗

[DNA polymorphism in beta-thalassemia: a study of 15 families in Tunisia].

In order to perform prenatal diagnosis of beta-thalassemia by DNA analysis in Tunisia, we investigated molecular defects and their frequencies. We have determined which haplotypes are associated with beta zero or beta +-thalassemia phenotypes. Six of the haplotypes described by Orkin were observed among 15 patients homozygous for beta zero (11) or beta +-thalassemia (4). We also investigated the molecular defects. The frameshift mutation in codon 6, characterized by Mst II seems more frequent than the beta 39 non sense mutation indicating that Tunisian patients differ from other Mediterranean patients from Algeria or Italy. Results concerning beta +-thalassemia are too preliminary to draw any conclusion. The study is currently being enlarged with other molecular probes and restriction enzymes.

DNA↗

Screening and genetic counseling for beta-thalassemia trait in a population unselected for interest: effects on knowledge and mood.

To evaluate the effects of genetic screening and counseling in a population unselected for interest, adults in a health maintenance organization (HMO) were screened for beta-thalassemia trait as part of health care or multiphasic screening. Counseling was provided by either a trained physician or a videotape containing the same information, followed by an opportunity to question a trained physician. Knowledge of thalassemia, knowledge of genetics, and mood were assessed by standardized questionnaires and by interview immediately before and after counseling. Compared to controls, trait subjects demonstrated significant learning about thalassemia (P less than .001) and about genetics (P less than .001) and recorded significant mood changes, namely, surprise (startle) (P less than .05), increased alertness (decreased deactivation) (P less than .05), and decreased skepticism (P less than .01). Screening and genetic counseling for beta-thalassemia trait conducted as part of multiphasic screening of the population of a HMO, essentially and unselected population, can result in significant overall learning with acceptable effects on mood.

Adult↗

Thalassemia and G-6-PD deficiency in Chinese-Canadians: admission screening of a hospital population.

Admission screening was performed on 684 Chinese-Canadian patients for thalassemia, abnormal hemoglobins and glucose-6-phosphate dehydrogenase (G-6-PD) deficiency. Thirty-six healthy Chinese adults were also studied. The incidence of beta-thalassemia minor (hemoglobin A(2) greater than 3.5%) was 3.8%. Presumptive alpha-thalassemia minor (demonstration of occasional red cells containing hemoglobin H inclusion bodies) was found in 6.7%. Two patients had findings consistent with alpha-beta-thalassemia. The incidence of G-6-PD deficiency (abnormal methemoglobin reduction test) in adult males was 4.7%. In a parallel study the incidence of hemoglobin Bart's in 310 Chinese newborns was 6.8%. Two mutant hemoglobins were found - hemoglobin E and hemoglobin J (Bangkok).

Adult↗

Thalassemia in Canadians.

Thirteen Canadians with a mild hypochromic anemia were found to have beta thalassemia trait. The families of these individuals had resided in Canada for two to five generations and, where known, had not emigrated from areas with a high incidence for the thalassemia gene. A Negro family with abnormal erythrocyte morphology was suspected to be carrying the thalassemia gene although the hemoglobin A(2) concentration was normal and abnormal minor components were not detected. Thalassemia trait has been detected in practically every ethnic group, and its sporadic occurrence among Canadians without Mediterranean ancestry can be expected.

Adult↗

[Reproductive compensation in the mothers of patients with homozygous beta-thalassemia].

The results of examination of fertility of 74 females, residents of Kutcashen and Vartashen districts of Azerbaijan, are presented. The data obtained have shown an increased fertility in females with beta-thalassemia. The value for fertility of the total everborn for mothers with beta-thalassemia is 1.25. These findings indicate that there is some degree of reproductive compensation in families segregating for homozygous beta-thalassemia. The authors conclude that beta-thalassemia gene is maintained in this population at higher values (15,83%), due to the higher fertility of the heterozygous mothers.

Adult↗