为了研究临床,地中海贫血和血红蛋白病患者的血液学和分子特征,并将分子特征与临床和血液学表现相关联。材料:这项观察性横断面研究包括100名年龄12岁的所有性别慢性溶血性贫血和多次输血史的患者。进行了血液和放射学检查。临床,研究了血液学和分子特征。观察和临床:所有病例均出现苍白,32%的病例出现黄疸。总共48%的患者有肝肿大,98%的患者有脾肿大。在基因型中,15%的病例有α-地中海贫血,62%有β地中海贫血+δβ地中海贫血,7%有HbS血红蛋白病,16%患有HbE血红蛋白病。血液学:血红蛋白与地中海贫血的分子基因型显着相关,在β-地中海贫血δβ地中海贫血和HbE中最低。MCV与分子基因型显著相关,HbE的最低MCV为65.5fl。LDH水平与分子基因型显着相关,在HbS血红蛋白病中最高。分子特征:复合型α-地中海贫血常见突变为3.7、4.2和20.5缺失。至于β-地中海贫血和δβ地中海贫血,47例为杂合型,15例为纯合型。在β-地中海贫血中,纯合型显示IVS1-5(G→C),CD41/42(→CTT)和IVSII-654(G→T),杂合型显示CD16(→G),CD41/42(→CTT),IVS1-5(G→C),和IVSII-654(G→T)。在δβ地中海贫血中,杂合型显示δβ倒位突变。在HbS血红蛋白病中,杂合型显示密码子6(A→T),复合杂合型显示IVS1-5(G→C)和密码子6(A→T)。在HbE血红蛋白病中,纯合型显示CD26(G→A),复合杂合型显示IVS1-5(G→C)和IVSII654(G→T)。结论:在我们的研究中观察到的常见地中海贫血基因型是α-地中海贫血(15%),β地中海贫血+δβ地中海贫血,(62%)HbS血红蛋白病(7%),和HbE血红蛋白病(16%)。患者面色苍白,icterus,肝肿大,和脾肿大,在地中海贫血和血红蛋白病的所有分子基因型之间具有可比性。α-地中海贫血具有复合α-地中海贫血,常见突变为3.7、4.2和20.5缺失。至于β-地中海贫血和δβ地中海贫血,47例为杂合型,15例为纯合型。在δβ地中海贫血中,杂合子型5例出现δβ倒位突变。MCH,雷蒂克计数,铁蛋白商店,所有分子基因型的外周血涂片相似。血红蛋白,MCV和LDH与分子基因型显著相关。小细胞性低色素性贫血是最常见的。本研究的结果表明,地中海贫血的基因型具有多样性和显着的遗传异质性。
To
study clinical, hematological and molecular characteristics of patients of thalassemia and hemoglobinopathies and to correlate the molecular characteristics with clinical and hematological presentations. Material: This observational cross sectional
study included 100 patients of age >12 years of all genders with chronic haemolytic anemia and history of multiple blood transfusion. Blood and radiological investigations were done. Clinical, hematological and molecular characteristics were studied. Observation and Clinical: Pallor was present in all cases and icterus in 32% cases. Total 48% of the patients had
hepatomegaly and 98% had splenomegaly. Among genotypes, 15% cases had α-thalassemia, 62% had β thalassemia + δβ thalassemia, 7% had HbS hemoglobinopathy, and 16% had HbE hemoglobinopathy. Hematological: Hemoglobin showed significant association with molecular genotypes of thalassemia with lowest being present in β-thalassemia + δβ thalassemia and HbE.MCV showed significant association with molecular genotypes, with HbE having the lowest MCV of 65.5 fl. LDH levels showed a significant association with molecular genotype with highest being in HbS hemoglobinopathy. Molecular Characteristics: Common mutations in compound α-thalassemia were 3.7, 4.2 and 20.5 deletion. As for β-thalassemia and δβ thalassemia, 47 cases had heterozygous type and 15 cases had homozygous types. In β-thalassemia, the homozygous type showed IVS1- 5(G→C),CD 41/42(→CTT) and IVSII-654(G→T) while heterozygous type showed CD16(→G), CD 41/42(→CTT), IVS1-5(G→C), and IVSII-654(G→T) . In δβ thalassemia, the heterozygous type showed δβ inversion mutation.In HbS hemoglobinopathy, heterozygous type showed Codon 6(A→T) and compound heterozygous type showed IVS1- 5(G→C) and Codon 6(A→T). In HbE hemoglobinopathy,the homozygous type showed CD26(G→A) and compound heterozygous type showed IVS1-5(G→C) and IVSII 654(G→T). Conclusion: The common thalassemia genotypes observed in our study were α-thalassemia (15%), β thalassemia + δβ thalassemia, (62%) HbS hemoglobinopathy (7%), and HbE hemoglobinopathy (16%). The patients presented with pallor, icterus,
hepatomegaly, and splenomegaly which were comparable among all molecular genotypes of thalassemia and hemoglobinopathies. α-thalassemia had compound α-thalassemia with common mutations being 3.7, 4.2 and 20.5 deletion. As for β-thalassemia and δβ thalassemia, 47 cases had heterozygous type and 15 cases had homozygous types. In δβ thalassemia, the heterozygous type showed δβ inversion mutation in 5 cases. MCH, Retic count, ferritin stores, and peripheral blood smear were similar in all molecular genotypes. Hemoglobin, MCV and LDH showed a significant association with molecular genotypes. Microcytic hypochromic anaemia was commonest among all.The findings of the present
study show that the genotypes of thalassemia are characterized by diversity as well as significant genetic heterogeneities.