Detection of hemoglobin variants in erythrocytes by flow cytometry

BACKGROUND: With the emergence of fetal hemoglobin (Hb F)stimulating agents as potential treatments for sickle-cell disease and thalassemias, procedures to monitor the effect of these agents on Hb F levels in individuals will be needed. We developed a rapid procedure that detects fetal hemoglobin in erythrocytes (F cells) using a fluorescein isothiocyanate (FITC) conjugated monoclonal antibody against Hb F. METHODS: Ten microliters of washed blood was fixed in formaldehyde and glutaraldehyde, then permeabilized in a Triton X-100/PBS solution containing a FITC-labeled monoclonal antibody to Hb F. The blood was analyzed by flow cytometry to determine the percentage of F cells. RESULTS: Nearly 200 Hb F-containing samples were analyzed by this protocol and demonstrated good correlation to percent Hb F results determined by high pressure liquid chromatography (HPLC). In addition, a number of samples were fixed and permeabilized using this method as well as a previously-described method that uses dimethyl 3,3'dithiobispropionimadate (DTBP) as a fixative as well as a different anti-Hb F monoclonal. Good correlation (r = 0.96, r2 = 0.93, P<0.001) was observed between the two protocols. CONCLUSIONS: This procedure is easy, reproducible, and gives accurate F cell results. It can be used to measure a wide range of F cell percentages and may also be used to dual-stain Hb F along with other hemoglobin variants and erythrocyte surface antigens.     

Normal hematological values of the African neonate

A longitudinal study of normal hematological values of the newborn infant was undertaken in an effort to provide baseline data for assessing the African Neonate with hematological problems. There were 402 neonates, consisting of 304 full-term, 51 preterm and 47 post-term infants. The Hematocrit (Hct), Hemoglobin (Hb), Red Blood Cell Count (RBC), Reticulocyte count (Retic) and Nucleated Red Blood Cell Count (NRBC) were serially determined. The red cell indices, Mean corpuscular Hemoglobin (MCH), Mean Corpuscular volume (MCV) and Mean corpuscular Hemoglobin Concentration (MCHC) were calculated for each neonate. Our results showed that African neonates have lower hematological values than their North American and European counterparts. This was neither a reflection of an intrauterine anemia nor was it due to variables resulting from the timing of cord blood sampling. On the first day of life, the mean Hct was 45.4%; mean Hb was 15.46 gm/dl; and the RBC was 4.02 X 10(6) cells/mm2. The Retics, NRBC and other red blood cell indices do not differ from those of neonates reported from other parts of the world. We suggest therefore that the low hematological values of the African neonate may be intrinsic.     

Hematologic values of the endangered San Joaquin kit fox, Vulpes macrotis mutica

Between 1981 and 1982 blood samples were collected from 64 adult San Joaquin kit foxes, Vulpes macrotis mutica, in western Kern County, California. The goal of the study was to establish normal blood values for this endangered species, and to determine whether changes in them could be used to assess the possible effects of petroleum developments on these foxes. None of the values differed significantly between the sexes, or between foxes sampled in developed habitats compared with foxes sampled in undisturbed habitats. Mean values of Hb, MCH, MCHC, and WBC counts differed significantly between summer and winter. Average hematological characteristics were: RBC, 8.4 X 10(6)/microliter; Hb, 14.5 g/dl (summer), 15.6 g/dl (winter); PCV, 46.9%; MCV, 56.3 fl; MCH, 17.8 pg (summer), 18.4 pg (winter); MCHC, 31.2 g/dl (summer), 33.2 g/dl (winter); and WBC, 6,200/microliter (summer), 7,500/microliter (winter). Comparisons of hematological data for kit foxes, coyotes (Canis latrans), and wolves (Canis lupus) confirmed a previously published observation that within mammalian families RBC counts are correlated inversely with body weight, and that MCV is correlated directly with body weight.     

Increased incidence of hepatitis B markers in children with sickle-cell anemia

Screening of 143 children 6 months to 12 years of age with sickle-cell anemia showed that 39.2% were HBsAg-positive as compared with 19.3% of the 161 control children of the same age group, who had Hb genotype AA (chi 2 = 14.7383; P less than 0.001). Fifty percent of the HbSS children under the age of 1 year were HBsAg-positive as opposed to 4.3% of the control group (chi 2 = 9.1955; P less than 0.001), while 28.6% of patients were HBsAg-positive at the age of 4 years compared with only 7.4% of the controls at the same age. The incidence of anti-HBc in both groups was similar. Markers of HBV infection (HBsAg + anti-HBc) were, however, on the whole higher in the patients with sickle-cell anemia [88/118 (74.6%)] than in the controls [54/88 (61.3%; P less than 0.005)].     

Kinetics of the ontogenic and reversible hemoglobin switching in the mouflon (Ovis musimon) and sheep x mouflon hybrid.

1. Hemoglobin (Hb) switching in the perinatal life of wild mouflon (Ovis musimon) was characterized by the replacement of Hb F by 60% levels of Hb C, and subsequently of Hb C by Hb B. 2. The recently discovered Hb M variant was not replaced by Hb C; thus, Hb BM heterozygote newborns synthesized 30% Hb C at the expense of Hb B. 3. Hybrid B mouflon x B sheep synthesized only 5% Hb C at birth but were able to produce 30% Hb C in adult life following induced anemia. 4. Adult BB and BM mouflons, after the same extent of induced anemia, synthesized HB C levels similar to those produced at birth. The results indicate a mouflon beta-globin gene cluster arrangement similar to those of sheep and goat, the beta C gene having an intermediate expression. Results also suggest a selective disadvantage in hybrid animals.     

Prevalence of common α-thalassemia determinants in south Brazil: Importance for the diagnosis of microcytic anemia

Alpha thalassemia has not been systematically investigated in Brazil. In this study, 493 unrelated individuals from the southernmost Brazilian state of Rio Grande do Sul were screened for deletional forms of α-thalassemia. One hundred and one individuals had microcytic anemia (MCV < 80 fL) and a normal hemoglobin pattern (Hb A (2) < 3.5% and Hb F < 1%). The subjects were screened for - α(3.7) , - α(4.2) , - α(20.5) , - (SEA) and - (MED) deletions but only the - α(3.7) allele was detected. The - α(3.7) allele frequency in Brazilians of European and African ancestry was 0.02 and 0.12, respectively, whereas in individuals with microcytosis the frequency was 0.20. The prevalence of α-thalassemia was significantly higher in individuals with microcytosis than in healthy individuals (p = 0.001), regardless of their ethnic origin. There were also significant differences in the hematological parameters of individuals with - α(3.7) / αα, - α(3.7) /- α(3.7) and β-thalassemia trait compared to healthy subjects. These data suggest that α-thalassemia is an important cause of microcytosis and mild anemia in Brazilians.     

微量元素五项联合红细胞四项检测在小儿缺铁性贫血中的诊断价值

目的:探讨微量元素五项联合红细胞四项检测在小儿缺铁性贫血(IDA)中的诊断价值。方法:选取2013年1月至2016年1月于我院进行治疗的小儿缺铁性贫血(IDA)患儿130例作为缺铁性贫血(IDA)组及同期于我院进行常规体检的健康儿童40例作为对照组。检测和比较其钙、镁、铜、铁、锌、血红蛋白(Hb)、平均红细胞体积(MCV)、平均血红蛋白含量(MCH)、平均血红蛋白浓度(MCHC)水平,并比较微量元素五项、红细胞四项检查以及两者联合对IDA患儿的诊断效能。结果:缺铁性贫血(IDA)组患儿微量元素镁、铁、锌含量以及Hb、MCV、MCH及MCHC水平均明显低于对照组儿童,差异具有统计学意义(P0.05);两组儿童微量元素钙、铜含量比较差异不显著(P0.05)。微量元素五项联合红细胞四项的灵敏度、特异度、阳性预测值及阴性预测值均明显高于微量元素五项和红细胞四项(P0.05)。结论:IDA患儿微量元素镁、铁、锌含量以及Hb、MCV、MCH及MCHC水平较低,微量元素五项联合红细胞四项检测可以提高小儿IDA的检出率。     

Characterization of blood cells and hematological parameters in Cichlasoma dimerus (Teleostei, Perciformes)

The aim of the present study was to obtain a basic knowledge of the hematology of Cichlasoma dimerus. The morphological features of blood cells were described according to the observations made by light and electron microscopy. Erythrocytes, thrombocytes and four types of leucocytes: lymphocytes, monocytes, heterophils and eosinophils, were distinguished and characterized. Thrombocytes are the most abundant blood cells after erythrocytes and are recognized easily from lymphocytes by morphological features and size. Heterophils and eosinophils are PAS positive. Hematological indices (RBC, WBC, PCV, Hb, MCV, MCH, MCHC and leucocyte differential count) were measured in one blood sample from 30 adult fish captured in Esteros del Riachuelo, Corrientes, Argentina (27 degrees 25'S, 58 degrees 15'W). The reference interval and the mean were determined for each hematological parameter evaluated. Contrary to other species, the percent of heterophils was found to be high in relation to the percent of lymphocytes. Low lymphocyte counts occurred in C. dimerus, as compared to these found in other fishes. Compared to most teleosts, this species has similar mean values for PCV and Hb and slightly higher for RBC. Statistical analysis revealed that differences in hematological parameters between male and female fish were not significant.     

Protection afforded by sickle-cell trait (Hb AS): what happens when malarial selection pressures are alleviated?

A study of reproductive outcome in Mobile, AL was conducted among a large maternal cohort with sickle-cell disease (Hb SS), sickle-cell trait (Hb AS), and no hemoglobinopathies (Hb AA). It was found that mean gravidity and live births among Hb AS women were significantly higher than among Hb AA women. These findings were surprising since it is generally held that once malarial pressure is alleviated, any reproductive advantage that might be conferred by Hb AS would disappear and fertility levels would reach levels similar to or slightly less than that of Hb AA women. A search of the literature was subsequently conducted and a large cohort study of an African-derived population was found in the United Kingdom. Results from this study also showed that parity was significantly higher among Hb AS women compared to Hb AA women. If survivorship is similar among Hb AS and Hb SS women, findings from these two studies raise doubts whether directional selection is occurring against the Rb S allele in nonmalarial environments. Balancing selection may still be occurring.     

Changes in hematological parameters in free-living pigeons (Columba livia f. urbana) during the breeding cycle

The blood parameters—red blood cell (RBC) count, hematocrit (Ht), hemoglobin concentration (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC)—were studied for the first time in free ranging pigeons Columba livia f. urbana. The aim of the study was to establish a set of reference values for this ubiquitous urban species and to examine a potential influence of the factors such as sex and phase of the breeding cycle on the hematological parameters. Blood was sampled from the adult individuals of both sexes during the breeding cycle. Significant variations in Ht and Hb were observed, while RBC count remained unchanged. The lower hematocrit value and hemoglobin concentration found in both males and females during molt probably resulted from the increase of plasma volume not accompanied by an increase in RBC. On the other hand, a significant physiological stress of nutritional deficiency during this energy-consuming stage may manifest itself in the decreased Ht and Hb values. The higher values of Ht and Hb during the laying phase could be related to the dehydration status. There were no overall differences in MCV, MCH, and MCHC values in either of the breeding stage. A lack of sex dimorphism in the measured and calculated blood parameters was apparent. Data collected herein contribute to the better understanding of general physiology of the ubiquitous urban species. The knowledge of variation in the blood indexes with respect to sex and breeding stage is crucial before blood parameters can provide an useful information on physical condition of the bird.     

Hemoglobin G San José {\text{[}}\beta _{\text{2}} {\text{(A4)Glu}} \to {\text{Gly}}\alpha _{\text{2}} {\text{],}}β thalassemia,and α thalassemia in a sicilian family

A 3-year-old child of Sicilian origin was found to have a severe form of Cooley's anemia. Investigations were extended to other members of her family. In three, a rare beta-chain structural Hb variant, Hb G San José [beta 7 (A4) Glu to Gly], was observed: in the father of the porposita heterozygosity for the abnormal Hb was found to be coexistent with beta o thalassemia; two sisters had lowered MCV and MCH values and levels of the abnormal Hb significantly lower than in other heterozygotes for Hb G San José. The alpha-chain/total beta-chain synthesis ratios suggest an alpha-thalassemic-like effect. Their mother had lowered MCV and MCH values, an Hb A2 level in the upper limit of the normal range, and a balanced alpha-chain/beta-chain synthesis ratio. Therefore, the possibility of coexistence of an alpha thalassemia trait with a beta thalassemia trait in the mother of the proposita and with Hb G San José heterozygosity in the two sisters who had lowered levels of abnormal Hb is discussed.     

Treatment of Anemia in Inflammatory Bowel Disease– Systematic Review and Meta-Analysis

Background

Anemia is considered the most common systemic complication of inflammatory bowel disease (IBD). We aimed to provide all available evidence regarding the safety and efficacy of therapy existing today to correct anemia in IBD.

Methods

Systematic review and meta-analysis of randomized controlled trials that compared any treatment for anemia in patients with IBD. We searched electronic databases, conference proceedings and clinical trials registries. Two reviewers independently extracted data from included trials. The primary outcome was the effect of treatment for anemia in IBD on the hemoglobin (Hb) response, defined as rate of patients who achieved an increase of 2 g/dl in Hb concentration at the end of the follow-up. Secondary outcomes included disease severity scores, iron indices, Hb levels, inflammatory markers, adverse effects, and mortality. Dichotomous data were analysed by calculating the relative risk (RR) for each trial with the uncertainty in each result being expressed using 95% confidence intervals (CI). A fixed effect model was used, except in the event of significant heterogeneity between the trials (P<0.10, I²>40%), in which we used a random effects model.

Results

Nine trials fulfilled the inclusion criteria, to a total of 973 patients. We were able to perform meta-analysis for intravenous (IV) versus oral iron and for ESAs versus placebo. IV iron was associated with a higher rate of achieving Hb response in comparison to oral iron; RR 1.25 (95% CI 1.04–1.51, I² = 2%, 4 trials), CRP levels and disease activity indexes were not significantly affected by IV iron. IV iron was associated with a decrease in adverse events that required discontinuation of intervention and without an increase in serious adverse.

Discussion

Treatment for anemia in IBD should include IV iron and not oral iron replacement, due to improved Hb response, no added toxicity and no negative effect on disease activity.     

The silent carrier of beta thalassemia: interaction with the typical beta thalassemic trait.

The case of a girl affected by a Colley's disease of moderate severity is reported. A brother and a sister had levels of Hb F respectively of 18% and 45%. The father showed all the hematological signs of heterozygous thalassemia. The mother, however, was normal so far as osmotic fragility, red cell morphology, and Hb A2 level are concerned. In vitro hemoglobin chains biosynthesis was performed in all the subjects. Both the parents showed an alfa/non alfa ratio typical of beta thalassemia. Therefore, the mother has to be considered a "silent" carrier of the trait. The daughters and the son have a less severe Colley disease originating by such a double heterozygosity.     

Sickle-cell disease in a British urban community.

Seventy cases of sickle-cell disease were identified in the London Borough of Brent from records dating back to 1962. All but three were still alive and, with one exception, were recalled for confirmation of the diagnosis and to provide personal and family histories. The group consisted of 22 individuals with homozygous sickle-cell anaemia (Hb SS), 12 with sickle-cell/beta-thalassaemia double heterozygosity, 34 with sickle-cell/haemoglobin C disease (Hb SC), and two with the combination of haemoglobin S and hereditary persistence of fetal haemoglobin. They were predominantly of West Indian origin, more than half had been born in Britain, and most were aged under 25. The records for 304 patient admissions between 1962 and 1979 were analysed. There were 199 sickle-cell-disease-related admissions, 61 unrelated to sickle-cell disease, and 44 for pregnancy or its complications. Admissions per patient-year averaged less than one, except for children with Hb SS under the age of 5 years, who were admitted more frequently. The commonest reasons for admission were painful crises (74% of all admissions) and the "chest syndrome" (21%). There were four pneumococcal infections, all in children with Hb SS under the age of 8 years; all recovered. Three patients, aged 10, 15, and 50 years, died. The two children with Hb SS died in their sleep without gross evidence of sickling at necropsy. Multiple brain infarcts were found at necropsy in the 50-year-old woman with Hb SC who, having survived nine uneventful pregnancies, succumbed to an infection after cryosurgery to the cervix. Obstetric records were available for 18 term pregnancies in 11 women. Three antenatal sickling crises and three postpartum thromboembolic complications were encountered. There were no maternal or perinatal deaths. Fifteen asymptomatic individuals with sickle-cell disease were diagnosed as a result of routine screening procedures. There are likely to be many such individuals currently undiagnosed in the community. They urgently need identification because of their increased risks from pregnancy, surgery, and infection.     

%Hb A2, %Hb F, %G gamma values and the haplotypes in the beta-globin gene cluster in Japanese adults with elevated Hb F.

The percentages of minor adult hemoglobin (%Hb A2) in hemolysates and G gamma-globin chain (%G gamma) in fetal Hb (Hb F) of 15 individuals with elevated Hb F levels (2.0-11%) among 11,000 healthy Japanese adults were examined. Most of them might be carriers for the determinants of hereditary persistence of fetal hemoglobin. Subjects with less than 1.3% Hb A2, some of whom might be also carriers for delta-thalassemia determinants, had high G gamma values (54-70%). Those homozygous for a subhaplotype [+-----] 5' to the delta-globin gene had low to mid G gamma values (7-49%), while those homozygous for [-++-++] possessed high G gamma values (60-85%), but varied Hb F values (3.1-11%). Those heterozygous for the presence of the XmnI site 5' to (-158 bp to the cap site of) the G gamma-globin gene had mid to high G gamma values (53-65%). Factors for the high or low G gamma-globin gene expression in the Japanese adult with elevated Hb F level should be highly associated with a subhaplotype [-++-++] or [+-----], respectively.     

Admissions to hospital of children with sickle-cell anaemia: a study in south London.

Admissions to hospital of 171 children with sickle-cell anaemia, genotype Hb SS, were reviewed over a 20-year period. Altogether 887 admissions occurred in 797 patient-years. The commonest cause of admission was painful vaso-occlusive crisis. Appreciable morbidity also resulted from pulmonary disease, infection, and anaemic episodes. The complications resulting in the most severe illness were acute splenic sequestration, pneumococcal meningitis, and some episodes of erythroid hypoplasia resulting in very low haemoglobin concentrations. Most deaths occurred in children aged under 5. Mortality and morbidity could be reduced by measures including prophylaxis of pneumococcal infections and more active treatment of seemingly minor illness in children with sickle-cell anaemia.     

晚期胃肠癌患者化疗后血红蛋白水平与临床疗效的相关性分析

目的:本研究通过回顾性分析晚期胃肠癌患者化疗后血红蛋白(Hb)水平与其临床疗效的关系,为临床治疗提供依据。方法:选择2009年1月~2014年12月我院收治的晚期胃肠癌患者共85例,采用回顾性调查方法,对患者进行1~5年的随访,分别对患者化疗前后贫血发生情况、Hb水平与临床疗效的关系、Hb水平与患者平均生存时间的关系进行分析。结果:化疗后患者发生贫血的比例(78.82%)明显高于化疗前(48.24%),差异有统计学意义(P0.05);PR组和SD组患者化疗前后Hb值的差异无统计学意义(P0.05);化疗前PD组患者Hb值显著高于化疗后,差异有统计学意义(P0.05);Hb水平越高,患者的平均生存时间越长,Hb的水平和患者的生存时间呈正相关。结论:晚期胃肠癌患者化疗后贫血发生率增加,化疗后Hb水平的变化与患者的预后和生存时间均存在相关关系,对患者进行常规治疗的同时采取相应措施纠正患者贫血症状,有利于改善晚期胃肠癌患者的预后,延长患者的生存时间。     

Benign Obstetric History in Women with Sickle-cell Anaemia Associated with α-Thalassaemia

Two Ghanaian women with sickle-cell anaemia and α-thalassaemia were found to have an unusually benign obstetric history. In addition to two factors present which are known to moderate the clinical course of sickle-cell anaemia, good socioeconomic status and a relatively high Hb F level, it is suggested that α-thalassaemia may act among other things by lowering the haemoglobin concentration in the red cells and thereby lowering their tendency to sickle in vivo.     

Genome-wide association study of porcine hematological parameters in a Large White × Minzhu F2 resource population

Hematological traits, which are important indicators of immune function in animals, have been commonly examined as biomarkers of disease and disease severity in humans and animals. Genome-wide significant quantitative trait loci (QTLs) provide important information for use in breeding programs of animals such as pigs. QTLs for hematological parameters (hematological traits) have been detected in pig chromosomes, although these are often mapped by linkage analysis to large intervals making identification of the underlying mutation problematic. Single nucleotide polymorphisms (SNPs) are the common form of genetic variation among individuals and are thought to account for the majority of inherited traits. In this study, a genome-wide association study (GWAS) was performed to detect regions of association with hematological traits in a three-generation resource population produced by intercrossing Large White boars and Minzhu sows during the period from 2007 to 2011. Illumina PorcineSNP60 BeadChip technology was used to genotype each animal and seven hematological parameters were measured (hematocrit (HCT), hemoglobin (HGB), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), mean corpuscular volume (MCV), red blood cell count (RBC) and red blood cell volume distribution width (RDW)). Data were analyzed in a three step Genome-wide Rapid Association using the Mixed Model and Regression-Genomic Control (GRAMMAR-GC) method. A total of 62 genome-wide significant and three chromosome-wide significant SNPs associated with hematological parameters were detected in this GWAS. Seven and five SNPs were associated with HCT and HGB, respectively. These SNPs were all located within the region of 34.6-36.5 Mb on SSC7. Four SNPs within the region of 43.7-47.0 Mb and fifty-five SNPs within the region of 42.2-73.8 Mb on SSC8 showed significant association with MCH and MCV, respectively. At chromosome-wide significant level, one SNP at 29.2 Mb on SSC1 and two SNPs within the region of 26.0-26.2 Mb were found to be significantly associated with RBC and RDW, respectively. Many of the SNPs were located within previously reported QTL regions and appeared to narrow down the regions compared with previously described QTL intervals. In current research, a total of seven significant SNPs were found within six candidate genes SCUBE3, KDR, TDO, IGFBP7, ADAMTS3 and AFP. In addition, the KIT gene, which has been previously reported to relate to hematological parameters, was located within the region significantly associated with MCH and MCV and could be a candidate gene. These results of this study may lead to a better understanding of the molecular mechanisms of hematological parameters in pigs.     

Survey of sickle-cell disease in England and Wales.

The incidence and the clinical course of patients suffering from sickle-cell syndrome (Hb SS; Hb SC; Hb S thal) in England and Wales are not known. In 1979 an ad hoc committee was formed to investigate these problems. Initially, a questionnaire was sent to 227 haematologists in England and Wales to determine the number of cases in these countries. The replies have indicated that 1367 cases were seen in 1978 and 1979. Probably this may represent only half the total number of cases. From this survey it has been possible to draw up a composite map showing the location of patients, which has provided a basis to determine the clinical course of the disease, and for further studies into the complications and management of sickle-cell disease in England and Wales. From a second questionnaire preliminary data about the general management and mortality in England and Wales have been recorded.