THAL Intermedia - Thalassemia Dubai
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Transcript THAL Intermedia - Thalassemia Dubai
Data from Dubai Thalassemia
Centre
Chromosome 11
-globin gene
Chromosome 16
-globin gene
An example of inheritance:
Marriage between two carriers
Red blood
cell
Oxygen from
lungs
Oxygen released
to tissue cells
Hemoglobin
molecules
Oxygen boded with
hemoglobin molecules
1. Homozygous or compound heterozygous
state for thalassemia
a) Inheritance of mild thalassemia
alleles
b) Co-inheritance of thalassemia
c) Increased Hb F response
Xmn1 –polymorphism
promoter mutations
Trans-acting HPFH genetic
determinants
2. Heterozygous state for thalassemia
a) Co-inheritance of extra globin genes
(/, /, /)
b) Dominantly inherited thalassemia
(Hyperunstable chain variants)
3. Compound heterozygous for thalassemia
and chain variants e.g. Hb E
4. Compound heterozygotes for thalassemia
and HPFH .
-Thalassaemia genotypes of
parents
HbF values in parents
Co-inheritance of thalassemia
Age at presentation
Level of Hb at presentation
Level of Hb A
All patients had:
Serial FBCs
Hb Electrophoresis (HPLC) &/ or IEF
Molecular characterization of alpha
genes ( Deletional and non-deletional)
Beta genes mutations &Xmn1
Clinical monitoring of any possible
complication
o +
HbA:
HbF:
HbA2:
Decreased
Inc(80-90 %)
Variable
+ +
HbA:
HbF:
HbA2:
Decreased(>20%)
Inc(70-80 %)
N or Increased
The mean age is 11 (3-33) yrs,
Non-deletional alpha-gene mutation was
normal in all our patients.
Most of pts have mild to moderate
thalassemic features.
Average hemoglobin level : 8.5 g/dl.
40% of patients had infrequent hemoglobin
drop needed blood transfusion.
600
500
509
400
82.52%
420
300
200
8.64%
44
100
8.84%
45
0
Total
BTM
No of pts
BTI
BMT
23%
44%
33%
severe mutation
mild mutation
mixed
70
60
62.5
50
40
30
20
10
37.5
25
15
0
no. of pts
%
male
female
9 = IVS 1 - 5 (G-C) / IVS 1 - 5 (G-C)
4 = IVS 1 - 5 (G-C) / - 25 bp del
3 = IVS 1 - 1(G-C) / IVS 1 – 1(G - C)
1 = IVS 1 - 1 (G-T) / IVS 1 - 1 (G - T)
1 = -25 bp del / -25 bp del
2= CD 26 (G-A) / Milder mutation
2= IVS 11–1 (G-C) / IVS 11 – 1
1= IVS 1-6 (T-C) / IVS 1-6 (T-C)
1= CD 27 (G-T) / CD 39 (G-T)
1= CD 26 (G-A) / IVS 1 – 130 (G-C)
2= VS 1-6 (T-C) / mild
2= IVS 1-6(T-C) / IVS II-848(C-A)
2 = Cd 8 (-AA) / Cd 8 (-AA)
2= IVS 1 - 5 (G-C) / - 88 (C-A)
3= IVS 1 - 5 (G-C) / Poly A
2= IVS 1– 5 (G-C) / CD 26 (G-A)
1= IVS 1 – 5 (G-C)/
1= -25 bp del / CD 27 (G-T)
14
12
14
10
8
10
6
4
2
6
6
4
0
No. of pts
Homozygous severe
Hetero mild/severe
Hetero severe
Hetero mild/mild
Homo mild
IVS 1-5(GC) =19
6, 32%
9, 47%
4, 21%
Homozygous
With severe
With mild
-Thal. Status
18 severe - mutation
6 homozygous
-thal 3.7
4 heterozygous
-thal 3.7
8 normal
- thal
14
12
13
13
10
8
9
6
4
5
2
0
Never tx
Rarely tx
Total
Severe mut.
Freq. tx
Mild mut.
Planned tx
4/20 (20%) patients received blood
transfusion rarely
4/4 (100%) are homozygous positive for
XmnI,
2/4 (50%) are heterozygous for –3.7
alpha-gene mutation (alpha-thalassemia
trait)
Xmn1
5-P/P
2- P/ - ve
14
12
10
13
No of pts
8
8
6
4
5
2
0
total
mild mutation severe mut.
1-Pt
a- Thal. Trait
2 PTS
SEVERE MUTATION
1 a-GENE DELETION
Xmn1-p/p
2 PTS
SEVERE MUTATION
N--gene
Deletional & nondeletional
N- Xmn1
Multifactorial
Delayed puberty
path. fracture
pregnancy
Thal. Features
0
0.5
1
1.5
2
2.5
3
Among the known factors affecting the
phenotypic severity in our pts.:
Type of Beta mutation.
The presence of alpha-gene defect.
XmnI mutation (homozygous and hetero)
would ameliorate the clinical course.
Two of our patients have severe mutation
with normal a-thal and normal Xmn1
Further studies still needed to specify
other factors.
Al Wasl Hospital, Genetic and
Thalassemia Center, Dubai, UAE.
Erol Baysal, PhD
Aref Chehal, MD
Maisam Bakir,MD
Essam Dohair, MD
Lab. Technicians
Nursing Staff
Abdulla Alkhayat.MD