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Hemoglobin H hastalığında genetik danışmanlık önemli midir?

Yıl 2023, Cilt: 48 Sayı: 2, 723 - 727, 02.07.2023
https://doi.org/10.17826/cumj.1283151

Öz

Alfa talasemi, α-globin zincirinin yetersiz ekspresyonu veya kesin yokluğu ile karakterize edilen genetik bir hastalıktır. Ülkemizde üç büyük delesyon (tal-1; 26.5 kb veya MedII, 20.5 kb ve 17.4 kb veya MedI) ve iki küçük delesyon (tal-2; 4.2 kb ve 3.7 kb) karakterize edilmiştir. Ayrıca α2-globin geninde (αα/αPAα), 5nt delesyonunda (αα/α5ntα) ve iki farklı PolyA mutasyonu (PA1: AATAAA>AATAAG ve PA2: AATAAA>AATGA) ve α1-globin geni (αα/αααCD59) tarafından sentezlenen kararsız Hb varyantı (CD 59; GGC→GAC) bildirilmiştir. α-thal-1 ve α-thal-2 (--/-α) veya nokta mutasyonlu (-/αPAα veya --/αααCD59) HbH genotiplerinin ondan fazla farklı kombinasyonu belirlenmiştir. Çukurova bölgesinde yapılan bu çalışmada alfa talasemi taşıyıcısı ailelere genetik danışmanlık verilmesinin öneminin vurgulanması ve genotip kombinasyonlarının belirlenmesi amaçlanmaktadır. Çukurova Üniversitesi Balcalı Hastanesi'ne başvuran ve kan sayımı sonucunda ağır anemi (Hb <9, MCV <70) tanısı alan 5 çocuk ve ailesinden alınan kan örneklerinden DNA izole edildi. HbA2 değerleri HPLC ile ölçüldü. Multipleks PCR ile gen delesyonları belirlendi. İki çocuklu iki aile karşılaştırıldığında, genetik danışmanlık hizmeti alan ailenin ikinci çocuğunun taşıyıcı, genetik danışmanlık hizmeti almayan ailenin ikinci çocuğunun ise hasta olması genetik danışma hizmetinin önemini vurgulamaktadıır.

Destekleyen Kurum

yok

Kaynakça

  • Çürük MA. HbH (β4) disease in çukurova. Southern turkey. Hemoglobin. 2007;2:265-71.
  • Vichinsky EP. Clinical manifestations of α-thalassemia. Cold Spring Harb Perspect Med. 2013;3:a011742.
  • Öner C, Gürgey A, Öner R, Balkan H, Gümrük F, Baysal E, Altay Ç. The molecular basis of HbH disease in turkey. Hemoglobin. 1997;21:41-51.
  • Lorey F, Charoenkwan P, Witkowska HE, Lafferty J, Patterson M, Eng B et al. HbH hydrops foetalis syndrome: a case report and review of literature. Br J Haematol. 2001;115:72-8.
  • Yüregir GT, Aksoy K, Cürük MA, Dikmen N, Fei YJ, Baysal E et al. HbH disease in a turkish family resulting from the interaction of a deletional alpha-thalassaemia-1 and a newly discovered poly a mutation. Br. J. Haematol. 1992;80:527-32.
  • Çürük MA, Kilinç Y, Evrüke C, Ozgünen F, Aksoy K, Yüreğir GT. Prenatal diagnosis of HbH disease caused by a homozygosity for the α2 poly A (AATAAA→ AATAAG) mutation. Hemoglobin. 2001;2:255-8.
  • Fei YJ, Oner R, Bozkurt G, Gu LH, Altay C, Gurgey A et al. HbH disease caused by a homozygosity for the AATAAA>AATAAG mutation in the polyadenylation site of the alpha 2-globin gene: hematological observations. Acta Haematol. 1992;88:82-5.
  • Çürük MA, Dimovski AJ, Baysal E, Gu LH, Kutlar F, Molchanova TP et al. Hb adana or alpha 2(59)(E8)Gly>Asp beta 2, a severely unstable alpha 1-globin variant, observed in combination with the -(alpha) 20.5 kb alpha-thal-1 deletion in two turkish patients. Am. J. Hematol. 1993;44:270-5.
  • Nainggolan IM, Harahap A, Ambarwati DD, Liliani RV, Megawati D, Swastika M et al. Interaction of Hb adana (HBA2: c.179G>A) with deletional and nondeletional α(+)-thalassemia mutations: diverse hematological and clinical features. Hemoglobin. 2013;3:297-305.
  • Li Y, Liang L, Qin T, Tian M. Detection of HbH disease by long molecule sequencing. J Clin Lab Anal. 2022;36:e24687.
  • Torti L. Life beyond alpha-thalassaemia: we are moving forward. Br J Haematol. 2022;199:11-3.
  • Chong SS, Boehm CD, Higgs DR, Cutting GR. Single-tube multiplex-pcr screen for common deletional determinants of alpha-thalassemia. Blood. 2000;95:360-2.
  • Chui DHK, Fucharoen S, Chan V. Hemoglobin h disease: not necessarily a benign disorder. Blood. 2003;10:791-800.
  • Greene DN, Vaughn CP, Crews BO, Agarwal AM. Advances in detection of hemoglobinopathies. Clin Chim Acta. 2015;439:50-7.
  • Fucharoen S, Viprakasit V. Hb h disease: clinical course and disease modifiers. Hematology Am. Soc. 2009;1:26-34.
  • Ünal S, Oktay G, Acıpayam C, İlhan G, Gali E, Celkan T et al. Hemoglobin h disease in turkey: experience from eight centers. Turk J. Haematol. 2016;1:56-9.
  • Luo S, Chen X, Chen L, Zhong Q, Wang Q, Xu Z et al. Analysis of hb levels and degree of anemia in relation to genotype in 615 patients with hemoglobin h disease. Expert Rev Hematol. 2020;13:1027-33.
  • Hamali HA, Saboor M. Undiagnosed hemoglobinopathies: A potential threat to the premarital screening program. Pak J Med Sci. 2019;35:1611-15.
  • Sermon K, Van Steirteghem A, Liebaers I. Preimplantation genetic diagnosis. Lancet. 2004;363:1633-41.
  • Viprakasit V. Alpha-thalassemia syndromes: from clinical and molecular diagnosis to bedside management. EHA Hematol Educ P. 2013;7:329-38.

Is genetic counseling important in hemoglobin H disease?

Yıl 2023, Cilt: 48 Sayı: 2, 723 - 727, 02.07.2023
https://doi.org/10.17826/cumj.1283151

Öz

Alpha thalassemia is a genetic disease characterized by insufficient expression or definite absence of the α-globin chain. Three large deletions (thal-1; 26.5 kb or MedII, 20.5 kb and 17.4 kb or MedI) and two small deletions (thal-2; 4.2 kb and 3.7 kb) have been characterized in our country. In addition, two different PolyA mutations (PA1: AATAAA>AATAAG and PA2: AATAAA>AATGA) on the α2-globin gene (αα/αPAα), 5nt deletion (αα/α5ntα), and unstable Hb variant (CD 59; GGC→GAC) synthesized by the α1-globin gene (αα/ααCD59) have been reported. More than ten different combinations of α-thal-1 and α-thal-2 (--/-α) or HbH genotypes with point mutations (--/αPAα or --/ααCD59) were determined. In this study, which was carried out in Çukurova region, it is aimed to emphasize the importance of giving genetic counseling to families with alpha thalassemia carriers and to determine genotype combinations. DNA was isolated from blood samples taken from 5 children and their families who were admitted to Çukurova University Balcalı Hospital and diagnosed with severe anemia (Hb <9, MCV <70) as a result of blood count HbA2 values were measured by HPLC. Gene deletions were determined by multiplex PCR. When two families with two children are compared, the fact that the second child of the family who receives genetic counseling service is a carrier and the second child of the family who does not receive genetic counseling service is patient highlights the importance of genetic counseling service.

Kaynakça

  • Çürük MA. HbH (β4) disease in çukurova. Southern turkey. Hemoglobin. 2007;2:265-71.
  • Vichinsky EP. Clinical manifestations of α-thalassemia. Cold Spring Harb Perspect Med. 2013;3:a011742.
  • Öner C, Gürgey A, Öner R, Balkan H, Gümrük F, Baysal E, Altay Ç. The molecular basis of HbH disease in turkey. Hemoglobin. 1997;21:41-51.
  • Lorey F, Charoenkwan P, Witkowska HE, Lafferty J, Patterson M, Eng B et al. HbH hydrops foetalis syndrome: a case report and review of literature. Br J Haematol. 2001;115:72-8.
  • Yüregir GT, Aksoy K, Cürük MA, Dikmen N, Fei YJ, Baysal E et al. HbH disease in a turkish family resulting from the interaction of a deletional alpha-thalassaemia-1 and a newly discovered poly a mutation. Br. J. Haematol. 1992;80:527-32.
  • Çürük MA, Kilinç Y, Evrüke C, Ozgünen F, Aksoy K, Yüreğir GT. Prenatal diagnosis of HbH disease caused by a homozygosity for the α2 poly A (AATAAA→ AATAAG) mutation. Hemoglobin. 2001;2:255-8.
  • Fei YJ, Oner R, Bozkurt G, Gu LH, Altay C, Gurgey A et al. HbH disease caused by a homozygosity for the AATAAA>AATAAG mutation in the polyadenylation site of the alpha 2-globin gene: hematological observations. Acta Haematol. 1992;88:82-5.
  • Çürük MA, Dimovski AJ, Baysal E, Gu LH, Kutlar F, Molchanova TP et al. Hb adana or alpha 2(59)(E8)Gly>Asp beta 2, a severely unstable alpha 1-globin variant, observed in combination with the -(alpha) 20.5 kb alpha-thal-1 deletion in two turkish patients. Am. J. Hematol. 1993;44:270-5.
  • Nainggolan IM, Harahap A, Ambarwati DD, Liliani RV, Megawati D, Swastika M et al. Interaction of Hb adana (HBA2: c.179G>A) with deletional and nondeletional α(+)-thalassemia mutations: diverse hematological and clinical features. Hemoglobin. 2013;3:297-305.
  • Li Y, Liang L, Qin T, Tian M. Detection of HbH disease by long molecule sequencing. J Clin Lab Anal. 2022;36:e24687.
  • Torti L. Life beyond alpha-thalassaemia: we are moving forward. Br J Haematol. 2022;199:11-3.
  • Chong SS, Boehm CD, Higgs DR, Cutting GR. Single-tube multiplex-pcr screen for common deletional determinants of alpha-thalassemia. Blood. 2000;95:360-2.
  • Chui DHK, Fucharoen S, Chan V. Hemoglobin h disease: not necessarily a benign disorder. Blood. 2003;10:791-800.
  • Greene DN, Vaughn CP, Crews BO, Agarwal AM. Advances in detection of hemoglobinopathies. Clin Chim Acta. 2015;439:50-7.
  • Fucharoen S, Viprakasit V. Hb h disease: clinical course and disease modifiers. Hematology Am. Soc. 2009;1:26-34.
  • Ünal S, Oktay G, Acıpayam C, İlhan G, Gali E, Celkan T et al. Hemoglobin h disease in turkey: experience from eight centers. Turk J. Haematol. 2016;1:56-9.
  • Luo S, Chen X, Chen L, Zhong Q, Wang Q, Xu Z et al. Analysis of hb levels and degree of anemia in relation to genotype in 615 patients with hemoglobin h disease. Expert Rev Hematol. 2020;13:1027-33.
  • Hamali HA, Saboor M. Undiagnosed hemoglobinopathies: A potential threat to the premarital screening program. Pak J Med Sci. 2019;35:1611-15.
  • Sermon K, Van Steirteghem A, Liebaers I. Preimplantation genetic diagnosis. Lancet. 2004;363:1633-41.
  • Viprakasit V. Alpha-thalassemia syndromes: from clinical and molecular diagnosis to bedside management. EHA Hematol Educ P. 2013;7:329-38.
Toplam 20 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Olgu Sunumu
Yazarlar

Yusuf Döğüş 0000-0002-0918-0621

Petek Çürük 0000-0002-8687-7772

Akif Çürük 0000-0002-4668-0852

Erken Görünüm Tarihi 11 Temmuz 2023
Yayımlanma Tarihi 2 Temmuz 2023
Kabul Tarihi 13 Haziran 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 48 Sayı: 2

Kaynak Göster

MLA Döğüş, Yusuf vd. “Is Genetic Counseling Important in Hemoglobin H Disease?”. Cukurova Medical Journal, c. 48, sy. 2, 2023, ss. 723-7, doi:10.17826/cumj.1283151.