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Identification of Sickle Cell Disease and Its Associated Other Structural Variants of Hemoglobin Using High
Dhirendra Kumar1, Lokeswara Bala Krishna S2, Sridevi Parikipandla3
1Department of Biotechnology, Indira Gandhi National Tribal University, Amarkantak, India.
Insights
Sickle cell disease (SCD) screening in India identified common Hb variants like HbSS, HbSF, and HbAS. Clinical profiling revealed increased severity with combined HbS and other hemoglobinopathies, particularly in females aged 21-30.
Area of Science:
- Hematology
- Medical Genetics
- Population Health
Background:
- Sickle cell disease (SCD) is a prevalent inherited blood disorder caused by hemoglobin mutations.
- SCD disproportionately affects tribal populations, with a notable presence in Madhya Pradesh, India.
- Understanding the spectrum of hemoglobinopathies associated with SCD is crucial for effective management.
Purpose of the Study:
- To identify and characterize SCD-associated hemoglobinopathies, focusing on alpha (α) and beta (β)-globin structural variants.
- To correlate hemoglobin variants with clinical severity and demographic factors in an Indian cohort.
- To evaluate the utility of comprehensive hemoglobinopathy screening and clinical profiling in SCD management.
Main Methods:
- Screening of over 1,200 symptomatic individuals for SCD.
- Utilized solubility tests, complete blood count (CBC), alkaline electrophoresis, and high-performance liquid chromatography (HPLC) for sample analysis.
- Detailed clinical profiling and comparative analysis of identified hemoglobin variants.
Main Results:
- Identified high frequencies of HbSS (21.26%), HbSF (11.39%), and HbAS (63.73%) among positive samples.
- Detected other significant variants including HbJ, Hb D-Punjab, and Hb Lepore.
- HPLC analysis revealed numerous β-variants (99), α-variants (115), tetramers (12), and δβ-hybrid Hb variants (8). Increased severity was noted with combined HbS and other hemoglobinopathies, with a higher prevalence in females aged 21-30.
Conclusions:
- Comprehensive hemoglobinopathy screening, including electrophoresis and HPLC, is effective in identifying diverse Hb variants in SCD patients.
- Clinical profiling alongside genetic analysis provides critical insights into disease severity and patient stratification.
- The findings underscore the importance of targeted screening programs in high-prevalence regions like tribal India for better SCD patient care.
Abstract:
Sickle cell disease (SCD), a well known hemoglobinopathy, is a recessive inherited blood abnormality caused by point mutation in hemoglobin proteins, notably prevalent in the tribal belt of Madhya Pradesh, India. The study aims to identify the SCD-associated hemoglobinopathies related to α- and β-globin structural variants. Over 1,200 symptomatically positive SCD individuals were screened and 503 solubility test positive samples were identified and further complete blood count (CBC) analysis showed 382 participants with abnormal hemoglobins. Confirmatory tests were alkaline electrophoresis on cellulose acetate membrane and high performance liquid chromatography (HPLC). Our study identified Hb variants, including HbSS (21.26%), HbSF (11.39%), and HbAS (63.73%). Other prevalent variants are HbJ, Hb D-Punjab, and Hb Lepore. Moreover, based on the HPLC retention time, 99 β-variants, 115 α-variants, 12 tetramers, and eight δβ-hybrid Hb variants, with six samples serving as a control for comparative analysis. Additionally, clinical profiling showed that severities are increased in combination with HbS along with other hemoglobinopathies. Further, the study reveals that Hb variants are prevalent in females, between age group of 21-30 years showing highest frequency of SCD. This study emphasizes the effectiveness of complete hemoglobinopathy screening and clinical profiling for measuring the normal and pathological conditions of the sickle cell patients.
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