The Challenging Diagnosis of Treacherous Hemoglobinopathies
|
|
- Adele Marsh
- 5 years ago
- Views:
Transcription
1 The Challenging Diagnosis of Treacherous Hemoglobinopathies David F. Keren, M.D. Professor of Pathology The University of Michigan
2 Objectives Use Capillary Electrophoresis and HPLC to detect clinically significant variants Decide which cases need molecular confirmation Distinguish carryover and transfused variants from slow eluting treacherous ones
3 Hemoglobin Structure
4 Adult Hemoglobins Alpha Globin Gene Cluster (Chromosome 16) Hb A a2b2 >95% Hb A2 a2d Hb F a2g2 <1% 5 z a2 a1 3 Beta Globin Gene Cluster (Chromosome 11) 5 3 e G g A g d b
5 ~1,000 Variant Hemoglobins Most Variants are Asymptomatic Structural Variants Alpha: Hb G Philadelphia Beta: Hb S, Hb C, Hb D, Hb O Delta: Hb A2ꞌ Structural & Thalassemia Constant Spring (alpha variant) HbE (beta variant) Lepore (delta-beta fusion protein)
6 Investigation of Hemoglobin Clinical: age, transfusion, race, therapy Routine: RBC, MCV, MCH, RDW, sickle solubility Analytical Alkaline & Acid electrophoresis HPLC (Hb A2 & Hb F) Cationic exchange: several types Capillary Electrophoresis (CE) High ph (10.0) Confirm Variant: two methods Referral: Mass spectrometry/molecular
7 Gel Electrophoresis Alkaline conditions ph 8.6 Densitometry for fractionation (inadequate for Hb A2 and Hb F) Cannot differentiate: Hb A2, C, O, or E Hb S, D, G Acid conditions ph 6.5 Differentiates: D & G from S (but can t tell D from G) E & O from C
8 Alkaline Gel Acid Gel C S F A A2 S F A S F Köln F A C S F (C) F E A E A S G S/G A A2 S A F A J A2 A/Chicago A2 S (F) A C S (A) A2 S A + Anode F A S C F A S F S F Köln /A F S C F (C) E/A E/A A G/S A S F A/J (F) A/Chicago A S (A) S C (F) A S + Anode Carbonic Anhydrase ( ) denotes low concentration
9 High Performance Liquid Chromatography (HPLC) Improved Sensitivity over gels Accurate measurement of Hb A2 and Hb F Complex patterns for interpretation Hb S adducts interfere with Hb A2 Cannot separate Hb A2 from Hb S Cannot separate Hb A2 from Hb E on most systems
10 Glycated HbA Aged HbA Bio-Rad Variant-II HPLC Hb A Degradation products Hb A2
11 Szuberski et al. Int J Lab Hematol 2013;34: Common Variants in Windows
12 Capillary Electrophoresis Positive buffer ions (+) flow to cathode m diameter Fused silica capillary tube 20 cm long Hb A Hb F b-1 Hb S Hb A2 35 o C ph nm UV Detector Anode + Sample - Cathode
13 Sebia Capillarys
14 Capillarys 2 Precision Riou J et al. Am J Clin Pathol 2018;149:172
15 Variants Zones 2-5 Riou J et al. Am J Clin Pathol 2018;149:172
16 Case year old woman RBC Hgb MCV MCH RDW Hb A 58.5 >95 Hb A Hb F 0 <2.0 Hb
17 Elution time of Unknown = 4.33 Szuberski et al. Int J Lab Hematol 2013;34: Variant Chain Mean Range % in Trait # Cases Stanleyville-II α % 42 Russ α % 40 Richmond β % 26 S β % 38038
18 Capillary Electrophoresis 214 Fractions % Ref. % Hb A Hb F 0.2 <2.0 Hb Hb A
19 Migration of Unknown = 214 Sebia Capillarys X-axis migration positions
20 2 beta genes Beta vs Alpha Variants usually are between 35-45% Hb A2 is unaffected (unless the beta variant elutes on top of it) 4 alpha genes Variants are ~25-30% There is a Variant version of A2 as well as normal A2 (add them together to find total A2
21 What does an Alpha Chain Variant look like? Hb G Philadelphia Hb A Hb G Philadelphia Hb A2 Hb G2
22 Hb G-Philadelphia a68 Asn Lys 1 in 5,000 African Americans Co-inherited with cis 3.7 Kb alpha deletion Benign Variant a genes b d g a1 a 2 b 2 Hb A a 2 d 2 Hb A2 a 2 g 2 Hb F a2 a 2 b 2 Hb A a 2 d 2 Hb A2 a 2 g 2 Hb F a1 G a G 2b 2 Hb G a G 2d 2 Hb G2 a G 2g 2 Hb F G a2 3.7 Kb Del - - -
23 Hb S b6 Glu Val Trait Hb S trait in 8% of African Americans Usually asymptomatic Hematuria ~ 1% of cases Rare sickling (deoxygenation): high altitude, pneumonia, strenuous exertion in warm weather Hb S 35-40% Hb A2 falsely high on HPLC- Hb S glycation Can use sickle solubility as confirmatory
24 Beta globin products in Thalassemia with & without Hb S Normal b Thal Hb S Trait Hb S/b Thal
25 Case year old African-American female with severe joint and abdominal pain RBC Hgb MCV MCH RDW Hb A 0 >95 A Hb Hb F 10 <2.0
26 Elution time of Unknown = 4.41 Szuberski et al. Int J Lab Hematol 2013;34: Variant Chain Mean Range % in Trait # Cases Stanleyville-II α % 42 Russ α % 40 Richmond β % 26 S β % 38038
27 Case 2. Capillary Electrophoresis Pt mixed with Normal blood Hb 2 Hb A Hb 214 Hb F/var Hb A2 Hb F/var Hb A2 Name % Hb A 0 Hb F or var 8.8 Hb Hb A2 2.9 Name % Hb A 68.4 Hb F or var 3.3 Hb Hb A2 2.7
28 Variants Zones 2-5 Riou J et al. Am J Clin Pathol 2018;149:172
29 Do we need further testing? None needed Sickledex? Confirms Hb S Cannot confirm other variants Mass Spectrometry? Confirms Hb S Detect and identify other variants Molecular? Confirms Hb S Detect and identify other variants Detect Thalassemic deletions
30 Common TreacherousVariants Modified from Williams & Weatherall Cold Spring Harbor Perspectives in Medicine 2012 Variant Amino Acid Pathologic Form Clinical Hb S b6 Glu Val Hb SS, HbS/b-thalassemia* Severe Hb D b121 Gl Gln Hb S/Hb D, Hb D/b-thalassemia* Severe Hb O-Arab b121 Glu Lys Hb S/Hb O-Arab Severe Hb C-Harlem (C-Georgetown) b6 b73 Glu Val Asp Asn Hb S/Hb C-Harlem Severe Hb C b6 Glu Lys Hb S/Hb C Mild- Moderate Hb Lepore (d-b Hybrid) d(1-87) b( ) Hb S/ Hb Lepore Mild- Moderate Hb E b26 Glu Lys Hb E/b-thalassemia* Moderate- Severe *Either b 0 or severe b + thalassemia
31 Hb S accounts for 83.3% Annual Births with Major Hemoglobin Disorders Williams and Weatherall Cold Spring Harbor Perspectives in Medicine 2012 Hb SS disease 217, % Hb SC disease 54, % b-thalssemia Major 22, % Hb E b-thalssemia 19, % Hb S b-thalssemia 11, % Hb H disease 9, % Hb Bart s hydrops (a 0 /a 0 ) 5, %
32 SS Worldwide Location Piel FB, Steinberg MH, Rees DC. NEJM 2017;376:
33 Hb SS b6 Glu Val Prognosis In the US: Life expectancy reduced ~30 years Quality of life often poor Hydroxyurea therapy increases Hb F Hematopoietic stem-cell transplantation In Africa: Mortality younger than 5 yr up to 90%
34 Pathophysiology Deoxygenation-polymerization of Hb S Erythrocyte Damage Hemolytic anemia Vaso-occulsion: Ischemic tissue damage Severe pain Organ failure
35 Case yr old African-American male-acute chest syndrome, Nl ferritin. On Hydroxyurea. RBC Hgb MCV MCH RDW Hb A 0 >95 A Hb S Hb F 15.1 <2.0
36 Case 3 Capillary Electrophoresis Hb 2 Hb A Hb S Hb F Hb A2 Hb F Hb A2 Hb F Hb 2 Hb A
37 Differential for Hb S with Microcytosis with relatively high hemoglobin RBC Hgb MCV MCH RDW Hb A 0 >95 A Hb S Hb F 15.1 <2.0 Hb S/b thalassemia Hb SS/a thalassemia Hb S/db thalassemia Hb S/HPFH Hb SS & Fe deficiency Molecular Tested Needed
38 Molecular Report Hb SS Homozygote gap-pcr: Negative for HPFH, db Thalassemia Promoter regions of g-globin gene: Homozygous C>T polymorph (Xmn I site) Associated with elevated Hb F Alpha gene deletions: Homozygous alpha-globin deletions (- a 3.7 /- a 3.7 ) Associated with microcytosis
39 Hb SS Genetic Modifiers Piel FB, Steinberg MH, Rees DC. NEJM 2017;376: Arab Indian Senegal Haplotypes Cameroon Benin Bantu/CAR * High Levels Hb F Low Levels Number of a-globin genes Two Three Four *CAR: Central African Republic
40 Case y/o female RBC Hgb Hct MCV MCH RDW HbA 97.7 >95 A HbF 0.8 <2.0
41 No variants are assigned by Variant II for Elution time prior to ~40 Seconds Szuberski et al. Int J Lab Hematol 2013;34:
42 Case 4. Capillary Electrophoresis HbA Anode + Hb 38 Hb 92 HbA2 Fractions % Ref Hb H Hb Hb A 82.2 >95 Hb A
43 Migration of Unknowns 38 & 92 Hemoglobin Alternative name Involved Chain migration Hb H b4 7 to 46 Hb Bart's g4 79 to 106 Hb J-Oxford Hb I-Interlaken a1 96
44 Hb H Disease RBC Hgb Hct MCV MCH RDW HbA 97.7* >95 A HbF 0.8 <2.0 Bart s/h/bilirubin HbH * Fast peaks NOT measured
45 Capillary Electrophoresis HbA Hb 38 H Hb 92 Bart s HbA2 Fractions % Ref Hb H Hb Barts Hb A 82.2 >95 Hb A
46 Alpha Thalassemia Affects 5% of the World Population US and Canada increasingly common 95% of cases due to deletion Double deletions- Alpha Thal 1 haplotype Southeast Asian (-- SEA, -- FIL, & -- THAI ) Mediterranean (-- MED, & ) Single Gene- Alpha Thal 2 haplotype (African): 3.7 & 4.2 kb
47 Hemoglobin H Disease a2 X a1 X X Less than 1/3 of alpha globin is produced Unstable high O 2 affinity Hb H (b4) & Bart s (g4) Severe microcytosis (MCV 55-62) & H-bodies HbA2 always low (<2.0) Mild-moderate hemolytic anemia, splenomegaly Usually not requiring transfusion Can transmit Bart s Hydrops fetals (g4)
48 H-bodies
49 Case y/o female RBC Hgb Hct MCV MCH RDW HbA 97.3 >95 A HbF 0 <2.0 Hb C window
50 Elution time of Unknown = 5.07 Szuberski et al. Int J Lab Hematol 2013;34: Variant Chain Mean Range % in Trait # Cases Porto Alegre β % 4 Constant Spring α % 512 C β % 9062
51 Capillary Electrophoresis Winichagoon et al. Translational Research 2008;152: Hb A Hb 38 Hb 92 Hb F Hb A2 Hb 258 Hb Hb Hb A 90.9 >95 Hb A Hb
52 Migration of Unknowns 38, 92 & 258 Hemoglobin Alternative name Involved Chain migration Hb H b4 7 to 46 Hb Bart's g4 79 to 106 Hb J-Oxford Hb I-Interlaken a1 96 Hb Constant Spring a Hb C b 252
53 Nondeletional Hb H Disease RBC Hgb Hct MCV MCH RDW HbA 97.3 >95 A HbF 0 <2.0 H Hb CS 1.7 Hb H/Constant Spring CS
54 Nondeletional Hb H Disease CS X X Relative product 1.0 Relative product 0 Referred to as a T alleles (transformed) TAA CAA Lose stop codon adds 31 C-terminal aa Unstable m-rna produces little CS a globin Hb CS 1% in heterozygote, 2-5% in Hb H disease CS homozygotes also have hemoglobin H disease Can transmit Bart s Hydrops fetals (g4)
55 Dealing with Carryover Kozarski TB et al. Arch Pathol Lab Med 2006;130: Slowly eluting Hb on HPLC-typically Hb C Check prior samples for Hb C If uncertain, repeat the sample No carryover on Capillary Electrophoresis
56 Unstable Hemoglobins Hardison RC et al variant hemoglobins categorized Hb Köln b89val Met - most common De novo Missense mutation leading to decreased solubility Mild to severe hemolytic anemias Detection depends on high index of suspicion Chronic non-spherocytic hemolytic anemia Retics increased out of proportion to Hb
57 Hb Köln by HPLC Li Y et al. Hemoglobin 2016;40:417-9
58 Capillary Electrophoreis Hb Köln Li Y et al. Hemoglobin 2016;40:417-9
59 Detection of Unstable Hemoglobins Positive Heinz body preparation is suggestive May be difficult to detect in young patients and ones with a functional spleen Heat stability &/or the isopropanol precipitation test are the best way to detect Mass spectrometry or Molecular studies are often necessary for specific identification
60 Case year African American male RBC Hgb MCV MCH RDW Hb A >95 Hb F 1.0 <2.0 Hb A
61 Elution of Unknown = 3.53 (8.2%) Szuberski et al. Int J Lab Hematol 2013;34: Variant Chain Mean Range % in Trait # Cases Lepore (δβ fusion) δβ % 523 G Copenhagen β % 30 E β % 5796
62 Capillary Electrophoresis Hb A Hb For var Hb 207 Hb A2 Name % Hb A 90.5 Hb F or var 0.5 Hb Hb A2 2.5
63 Migration of Unknown 207 Hb D-Punjab Hb Osu Christiansborg Hb D-Los Angeles b 208 b 207 Hb Lepore d/b hybrid 207 Hb G-Philadelphia a1 or a2 206
64 Hb Lepore (Boston) d(1-87) b( ) Co-elutes with Hb A2 on HPLC Separates from Hb A2 on Capillary A form of beta thalassemia Microcytosis Mild anemia Lepore/b 0 thalassemia yields severe anemia Hb S/Lepore moderately severe sickling
65 Lepore but why the Erythrocytosis? RBC Hgb MCV MCH RDW Hb A >95 Hb F 1.0 <2.0 Hb A
66 % Oxyhemoglobin Mayo Oxygen Dissociation on Pt 6 Inoue S et al. Hemoglobin 2012;36: P50 = 12 mm Hg P50 = mm Hg po2
67 Hb Johnstown Val Leu Codon 109 (GTG>TTG) Inoue S et al. Hemoglobin 2012;36:
68 Mayo 2011 Pretransfusion study from 2012 report by Inoue et al. Inoue S et al. Hemoglobin 2012;36: Hb Johnstown NOT Hb A Hb Johnstown NOT Hb A Hb Lepore & Hb A2 Hb Lepore Hb A2
69 High Oxygen Affinity Variants Thom CS, et al. Cold Spring Harbor Perspective in Medicine 2013;3: ~100 Variants Autosomal dominant May be alpha or beta variants Left shift in P50 values Many co-migrate with Hb A Compromise of oxygenation when combined with beta thalassemia
70 History Despite phlebotomy to relieve erythrocytosis: severe fatigue shortness of breath chest pain & palpitations Patient placed on monthly RBC exchange transfusions Now doing well
71 Case y/o woman RBC Hgb Hct MCV MCH RDW HbA 69.6 >95 A2&V HbF 1.0 <2.0
72 Elution time of Unknown = 3.69 Szuberski et al. Int J Lab Hematol 2013;34: Variant Chain Mean Range % in Trait # Cases Lepore (δβ fusion) δβ % 523 G Copenhagen β % 30 E β % 5796 Osu- Christiansborg β % 75
73 Same Case Capillary Electrophoresis HbA 228 HbF HbA2 Hb A 71.0 >95 Hb F 1.9 >95 <2.0 Hb <2.0 0 Hb A
74 Migration of Unknown 228 Hemoglobin Alternative name Involved Chain migration Hb Köln (peak 1) Hb Ube-1 b (presence of several peaks) 229 Hb E b 228 Hb M-Saskatoon: minor peak b (presence of several peaks) 227
75 Hb E Trait RBC Hgb Hct MCV MCH RDW HbA 69.6 >95 A2&V HbF 1.0 <2.0
76 Same Case Capillary Electrophoresis HbA Hb E HbF HbA2 Hb A 71.0 >95 Hb F 1.9 >95 <2.0 Hb E 23.8 <2.0 0 Hb A
77 Hemoglobin E b26 Glu Lys The mutation activates a cryptic splice site in Exon 1 in the beta globin gene producing b- Thalassemia Homozygotes and heterozygotes are clinically well with mild microcytosis Homozygotes have less than 10% HbF HbE/b 0 Thalassemia patients are severely anemic (may be as severe as Thalassemia Major) with elevated HbF 40% or higher
78 40 y/o woman Hb E Homozygote RBC Hgb Hct MCV MCH RDW HbA 0 >95 A2&E HbF 8.1 <2.0
79 39 y/o woman with Hb E/b 0 Thalassemia RBC Hgb Hct MCV MCH RDW F 43.8% A2 56.2% HbA 0 >95 A2&E HbF 43.8 <2.0 HbF 43.8% HbE & HbA2
80 Table from Steinberg et al. Disorders of Hemoglobin, Ch 43, 2001
81 Today s goals Capillary Electrophoresis and HPLC to detect clinically significant variants Use of molecular confirmation for some thalassemias and rare clinically significant variants: unstable, high oxygen affinity Distinguish carryover and transfused variants from slow eluting ones
Unraveling Hemoglobinopathies with Capillary Electrophoresis
Session Number 2002 Unraveling Hemoglobinopathies with Capillary Electrophoresis David F. Keren, M.D. Professor of Pathology Division Director, Clinical Pathology The University of Michigan dkeren@med.umich.edu
More informationHEMOGLOBIN ELECTROPHORESIS DR ARASH ALGHASI SHAFA HOSPITAL-AHWAZ
HEMOGLOBIN ELECTROPHORESIS DR ARASH ALGHASI SHAFA HOSPITAL-AHWAZ Hemoglobin Hemoglobin (Hb), protein constituting 1/3 of the red blood cells Each red cell has 640 million molecules of Hb sites in the cells:
More informationHaemoglobinopathies case studies 11 th Annual Sickle Cell and Thalassaemia Conference October 2017
Haemoglobinopathies case studies 11 th Annual Sickle Cell and Thalassaemia Conference 11 13 October 2017 Chris Lambert Haematology Service Delivery Manager Viapath Laboratories Kings College Hospital HUMAN
More informationThalassemias. Emanuela Veras, M.D. 01/08/2006
Thalassemias Emanuela Veras, M.D. 01/08/2006 Structure and Function of normal Hemoglobin molecules: 2/3 1/3 β: increases from 6 th week of fetal life to 12 months of age At birth: HbF: 75-90% HbA: 10-25%
More informationDetecting and Reporting Alpha Thalassemia In Newborns
Detecting and Reporting Alpha Thalassemia In Newborns T. Davis, C. Moore, L. Nayak, M.C. Dorley, M. del Pilar Aguinaga, M. Chan, J. Ubaike, C. Yusuf Alpha Thalassemia Screening Status in the US Clinical
More informationAnemia s. Troy Lund MSMS PhD MD
Anemia s Troy Lund MSMS PhD MD lundx072@umn.edu Hemoglobinopathy/Anemia IOM take home points. 1. How do we identify the condtion? Smear, CBC Solubility Test (SCD) 2. How does it present clincally? 3. How
More informationCurrent Topics in Hemoglobinopathies
Current Topics in Hemoglobinopathies Bruce R Haas, MS, LCGC 28-29 September 2015 bruce.r.haas@kp.org 1 How malaria escapes effective immunological responses P falciparum exports PfEMP1 proteins and concentrate
More informationThe diagnosis of Hemoglobinopathies
1ST IFCC, EFLM, AFCB CONFERENCE "LABORATORY MEDICINE: MEETING THE NEEDS OF MEDITERRANEAN NATIONS" Rome, Italy 02/07/2018 The diagnosis of Hemoglobinopathies Dr Antonino Giambona Unit of Hematology of Rare
More informationGenetic Modifiers of Sickle Cell Disease Severity. Kunle Adekile, MD, PhD Professor Department of Pediatrics Kuwait University
Genetic Modifiers of Sickle Cell Disease Severity Kunle Adekile, MD, PhD Professor Department of Pediatrics Kuwait University Outline Hb Molecule and Genetic control of globin synthesis Pathophysiology
More informationSICKLE CELL DISEASE. Dr. MUBARAK ABDELRAHMAN MD PEDIATRICS AND CHILD HEALTH. Assistant Professor FACULTY OF MEDICINE -JAZAN
SICKLE CELL DISEASE Dr. MUBARAK ABDELRAHMAN MD PEDIATRICS AND CHILD HEALTH Assistant Professor FACULTY OF MEDICINE -JAZAN Objective: The student should be able: To identify the presentation, diagnosis,
More informationComprehensive Hemoglobin Analysis HBA1/2 (
Comprehensive Hemoglobin Analysis HBA1/2 ( α-globin) and HBB (β-globin) mutation and deletion/duplication analysis and HBD (δ-globin) and HBG1/2 (γ-globin) mutation analysis Description: Hemoglobin (Hb)
More informationChem*3560 Lecture 4: Inherited modifications in hemoglobin
Chem*3560 Lecture 4: Inherited modifications in hemoglobin Genetic modifications fall into two classes: Thalassemias, which are the result of failure to express globin genes. Thalassa is Greek for the
More informationIn adults, the predominant Hb (HbA) molecule has four chains: two α and two β chains. In thalassemias, the synthesis of either the α or the β chains
Thalassaemias Thalassemia Thalassemia is an inherited autosomal recessive blood disease. Associated with absence or reduction in a or b globin chains. Reduced synthesis of one of the globin chains can
More informationHemoglobinopathy and thalassemia detection
Hemoglobinopathy and thalassemia detection Traditional methods and a novel method capillary electrophoresis technology By Aigars Brants, PhD Published October 2011 In humans, two pairs of unlike globin
More informationMOLECULAR BASIS OF THALASSEMIA IN SLOVENIA
MOLECULAR BASIS OF THALASSEMIA IN SLOVENIA Dijana Plaseska-Karanfilska, MD, PhD Research Centre for Genetic Engineering and Biotechnology Georgi D. Efremov, Macedonian Academy of Sciences and Arts, Skopje,
More informationDiagnostic difficulties in prevention and control program for thalassemia in Thailand: atypical thalassemia carriers
Diagnostic difficulties in prevention and control program for thalassemia in Thailand: atypical thalassemia carriers Pranee Winichagoon Fucharoen Thalassemia Research Center Institute of Molecular Biosciences
More information4 Fahed Al Karmi Sufian Alhafez Dr nayef karadsheh
4 Fahed Al Karmi Sufian Alhafez Dr nayef karadsheh Genetic variants of hemoglobin Hemoglobinopathies (abnormal variants of hemoglobin) are divided into: 1. Structural abnormalities: Any change in the genes
More informationDr.Abdolreza Afrasiabi
Dr.Abdolreza Afrasiabi Thalassemia & Heamophilia Genetic Reaserch Center Shiraz Medical University Hemoglobin tetramer Hemoglobin Structure % A 1 α 2 β 2 94-97% A 2 α 2 δ 2 2.5% A 1C α 2 (β-n-glucose)
More informationAn overview of Thalassaemias and Complications
An overview of Thalassaemias and Complications Haemoglobin Haemoglobin is the most abundant protein in blood, and exists as three main types in normal adults: HbA ( ) - 97% HbA 2 ( ) - 2.5% HbF ( ) - 0.5%
More informationPitfalls in the premarital testing for thalassaemia
Pitfalls in the premarital testing for thalassaemia Dr. Riad Amer MB ChB, MSc, FRCP, FRCPath, JBH Assistant Professor of Medicine Al Najah University Consultant Haematologist Case 1 Husband and Wife are
More informationDONE BY : RaSHA RAKAN & Bushra Saleem
DONE BY : RaSHA RAKAN & Bushra Saleem Hemolytic anemias (2 of 2) Sickle Cell Anemia The most common familial hemolytic anemia in the world Sickle cell anemia is the prototypical (and most prevalent) hemoglobinopathy
More informationHigh Hemoglobin F in a Saudi Child Presenting with Pancytopenia
Case Report imedpub Journals http://www.imedpub.com Journal of Pediatric Care ISSN 2471-805X DOI: 10.21767/2471-805X.100002 High Hemoglobin F in a Saudi Child Presenting with Pancytopenia Abstract Saudi
More informationGenetic Modulation on the Phenotypic Diversity of Sickle Cell Disease
Genetic Modulation on the Phenotypic Diversity of Sickle Cell Disease Malay B. Mukherjee Abstract Sickle cell hemoglobin is a β chain structural variant where valine is substituted for glutamic acid in
More informationEducational Items Section
Atlas of Genetics and Cytogenetics in Oncology and Haematology OPEN ACCESS JOURNAL AT INIST-CNRS Educational Items Section Hemoglobin genes; Sickle-cell anemia - Thalassemias Jean-Loup Huret, Xavier Troussard
More informationThe Thalassemias in Clinical Practice. Ashutosh Lal, MD Director Comprehensive Thalassemia Program UCSF Benioff Children s Hospital Oakland
The Thalassemias in Clinical Practice Ashutosh Lal, MD Director Comprehensive Thalassemia Program UCSF Benioff Children s Hospital Oakland Outline Thalassemia: definitions and pathophysiology Epidemiology
More informationHemoglobinopathies Diagnosis and management
Hemoglobinopathies Diagnosis and management Morgan L. McLemore, M.D. Hematology/Leukemia Department of Hematology and Oncology Winship Cancer Institute at Emory University mlmclem@emory.edu Disclosures
More informationBRITISH BIOMEDICAL BULLETIN
Journal Home Page www.bbbulletin.org BRITISH BIOMEDICAL BULLETIN Original A Long Term Screening of Iranian Populations with Thalassemia and Hemoglobinopathies Soudabeh Hosseini 1,2, Ebrahim Kalantar 3,2
More informationQuiz. What percentage of the world s population is a carrier of a hemoglobinopathy? Hemoglobinopathies in Pregnancy 1-2% 5-7% 8-12% 10-15%
Hemoglobinopathies in Pregnancy Emily Parkhurst, MS, LCGC Kaiser West Los Angeles November 2017 Genetics Department Quiz What percentage of the world s population is a carrier of a hemoglobinopathy? 1-2%
More informationHPLC profile of sickle cell disease in central India
Original Research Article HPLC profile of sickle cell disease in central India Shweta P. Bijwe * Department of Pathology, IGGMC, Nagpur, Maharashtra, India * Corresponding author email: dr.shwetabijwe@gmail.com
More informationScreening for haemoglobinopathies in pregnancy
Policy Statement All Southern Health patients will receive clinical care that reflects best practice and is based on the best available evidence. Index of chapters within background 1. Prevalence of haemoglobinopathies
More informationWhich variant haemoglobins are relevant? Haemoglobinopathies in the Diagnostic Laboratory. Which thalassaemias are relevant? Variant haemoglobins
Haemoglobinopathies in the Diagnostic Laboratory Barbara J Bain, Gold Coast, 2011 Which variant haemoglobins are relevant? Detection of variant haemoglobins is important for three reasons Genetic significance
More informationH aemoglobin A2 can be measured by several laboratory
276 ORIGINAL ARTICLE Some observations on the measurement of haemoglobin A 2 and S percentages by high performance liquid chromatography in the presence and absence of a thalassaemia C E Head, M Conroy,
More informationHEMOLYTIC ANEMIA DUE TO ABNORMAL HEMOGLOBIN SYNTHESIS
Hemolytic Anemia Due to Abnormal Hemoglobin Synthesis MODULE 19 HEMOLYTIC ANEMIA DUE TO ABNORMAL HEMOGLOBIN SYNTHESIS 19.1 INTRODUCTION There are two main mechanisms by which anaemia is produced (a) Thalassemia:
More information6.1 Extended family screening
CHAPTER 6 CONCLUSION Cost benefit analysis of thalassemia screening programs have shown that the single years treatment for a β-thalassemia major patient was much higher than a total cost per case prevented.
More informationPrevalence of Thalassemia in Patients With Microcytosis Referred for Hemoglobinopathy Investigation in Ontario A Prospective Cohort Study
Hematopathology / PREVALENCE OF THALASSEMIA IN ONTARIO Prevalence of Thalassemia in Patients With Microcytosis Referred for Hemoglobinopathy Investigation in Ontario A Prospective Cohort Study John D.
More informationThalassemia Maria Luz Uy del Rosario, M.D.
Thalassemia Maria Luz Uy del Rosario, M.D. Philippine Society of Hematology and Blood Transfusion Philippine Society of Pediatric Oncology What is Thalassemia Hereditary Hemoglobin disorder Hemolytic anemia
More information4 Jumana Jihad Dr. Ahmad Mansour Dr. Ahmad Mansour
4 Jumana Jihad Dr. Ahmad Mansour Dr. Ahmad Mansour Anemia Decreased blood production Increased blood loss Hemolytic Hemorrhage Extravascular Intravascular Hemolytic (Further classification( Extrinsic Intrinsic
More informationCOEXISTENCE OF β-thalassemia AND POLYCYTHEMIA VERA: A CHICKEN-AND-EGG DEBATE?
COEXISTENCE OF β-thalassemia AND POLYCYTHEMIA VERA: A CHICKEN-AND-EGG DEBATE? M. DE SLOOVERE (1), L. HARLET (2), S. VAN STEENWEGHEN (3), E. MOREAU (1), D. DE SMET (1) (1) DEPARTMENT OF LABORATORY MEDICINE,
More informationReport of Beta Thalassemia in Newar Ethnicity
Report of Beta Thalassemia in Newar Ethnicity Rajendra Dev Bhatt 1*, Surendra Koju 2, Prabodh Risal 1 Affiliations: 1 Department of Clinical Biochemistry, Dhulikhel Hospital, Kathmandu University Hospital
More informationNational Haemoglobinopathy Reference Laboratory. Information for Users
National Haemoglobinopathy Reference Laboratory Information for Users Summary The NHRL offers a service for the identification of haemoglobinopathy genotypes by the molecular analysis of DNA and haematological
More informationEXTERNAL QUALITY ASSESSMENT FOR HAEMOGLOBIN A 2
EXTERNAL QUALITY ASSESSMENT FOR HAEMOGLOBIN A 2 Dr Barbara abaawild The importance of Hb A 2 measurement Accurate and reliable measurement of Hb A 2 is essential for the diagnosis of beta thalassaemia
More informationHemolytic anemias (2 of 2)
Hemolytic anemias (2 of 2) Sickle Cell Anemia The most common familial hemolytic anemia in the world Sickle cell anemia is the prototypical (and most prevalent) hemoglobinopathy Mutation in the β-globin
More informationHaemoglobin BY: MUHAMMAD RADWAN WISSAM MUHAMMAD
Haemoglobin BY: MUHAMMAD RADWAN WISSAM MUHAMMAD Introduction is the iron-containing oxygen transport metalloprotein in the red blood cells Hemoglobin in the blood carries oxygen from the respiratory organs
More informationLABORATORY DIAGNOSIS OF HEMOGLOBINOPATHIES
LABORATORY DIAGNOSIS OF HEMOGLOBINOPATHIES Abdullah Kutlar Sickle Cell Center, Georgia Health Sciences University, USA Introduction Hemoglobinopathies include qualitative and quantitative disorders of
More informationA Counseling Guide for Sickle Cell and Other Hemoglobin Variants
A Counseling Guide for Sickle Cell and Other Hemoglobin Variants The Virginia Sickle Cell Awareness Program Virginia Department of Health Division of Women s and Infant s Health 109 Governor Street Richmond,
More informationComparison of Sebia Capillarys Capillary Electrophoresis With the Primus High-Pressure Liquid Chromatography in the Evaluation of Hemoglobinopathies
Hematopathology / Evaluation of Hemoglobinopathies Comparison of Sebia Capillarys Capillary Electrophoresis With the Primus High-Pressure Liquid Chromatography in the Evaluation of Hemoglobinopathies David
More informationCover Page. The handle holds various files of this Leiden University dissertation.
Cover Page The handle http://hdl.handle.net/1887/35456 holds various files of this Leiden University dissertation. Author: Hassan, Suha Mustafa Title: Toward prevention of Hemoglobinopathies in Oman Issue
More informationby Capillary Electrophoresis for Diagnosing β-thalassemia/ HbE Disease in Patients With Low HbF
Measurement of HbA by Capillary Electrophoresis for Diagnosing β-thalassemia/ HbE Disease in Patients With Low HbF Watcharee Prasing, BSc, 1 Sakorn Pornprasert, PhD 1 * Lab Med Summer 1;5:-3 DOI: 1.139/LMGD9HES3DZRBZM
More informationDr. Ayman Mohsen Mashi, MBBS Consultant Hematology & Blood Transfusion Department Head, Laboratory & Blood Bank King Fahad Central Hospital, Gazan,
Dr. Ayman Mohsen Mashi, MBBS Consultant Hematology & Blood Transfusion Department Head, Laboratory & Blood Bank King Fahad Central Hospital, Gazan, KSA amashi@moh.gov.sa 24/02/2018 β-thalassemia syndromes
More informationCAPILLARYS HEMOGLOBIN
CAPILLARYS HEMOGLOBIN TRAINING MANUAL Sebia, Inc. 1-800-835-6497 Copyright 2005 Sebia, Inc. All rights reserved. The content of this manual may change without notice. This manual may not be reprinted or
More information2018 Biochemistry 110 California Institute of Technology Lecture 7: Molecular Disease: Sickle-Cell Anemia
2018 Biochemistry 110 California Institute of Technology Lecture 7: Molecular Disease: Sickle-Cell Anemia James Herrick (1861-1954) Phase-Contrast microscopy image of Sickle Cells intermingled with erythrocytes.
More informationJMSCR Vol 06 Issue 01 Page January 2018
www.jmscr.igmpublication.org Impact Factor 5.84 Index Copernicus Value: 71.58 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v6i1.102 HPLC based evaluation of Haemoglobinopathies
More informationBatool Emad. Marah Karablieh. - Nayef Karadsheh
4 4 1 P a g e Batool Emad Marah Karablieh - Nayef Karadsheh ***Topics that will be discussed in this Lecture: 1) Globin gene organization 2) Hemoglobinopathies 3) HbS (sickle cell disease) 4) HbC and HbSC
More informationHaemoglobin Lepore in a Malay family: a case report
Malaysian J Pathol 2005; 27(1) : 33 37 HAEMOGLOBIN LEPORE CASE REPORT Haemoglobin Lepore in a Malay family: a case report Josephine PASANGNA MPath, *Elizabeth GEORGE FRCPA, FRCPE and Menaka NAGARATNAM
More informationThalassemias:general aspects and molecular pathology
Thalassemias:general aspects and molecular pathology Prof. Renzo Galanello Pediatric Clinic 2 University of Cagliari Ospedale Regionale Microcitemie-ASL8 HEMOGLOBINOPATHIES CLASSIFICATION Structurally
More informationIntroduction reduction in output alter the amino acid sequence combination
Sickle cell anemia. Introduction Mutations in the globin genes can cause a quantitative reduction in output from that gene or alter the amino acid sequence of the protein produced or a combination of the
More informationGenetics of Thalassemia
Genetics of Thalassemia Submitted by : Raya Samir Al- Hayaly Sura Zuhair Salih Saad Ghassan Al- Dulaimy Saad Farouq Kassir Sama Naal Salouha Zahraa Jasim Al- Aarajy Supervised by : Dr. Kawkab Adris Mahmod
More informationCLINICAL AND HEMATOLOGICAL PHENOTYPE OF HOMOZYGOUS HEMOGLOBIN E: REVISIT OF A BENIGN CONDITION WITH HIDDEN REPRODUCTIVE RISK
CLINICAL AND HEMATOLOGICAL PHENOTYPE OF HOMOZYGOUS HEMOGLOBIN E: REVISIT OF A BENIGN CONDITION WITH HIDDEN REPRODUCTIVE RISK Kalaya Tachavanich, Vip Viprakasit, Worawut Chinchang, Waraporn Glomglao, Parichat
More informationHAEMOGLOBINOPATHIES. Editing file. References: 436 girls & boys slides 435 teamwork slides. Color code: Important. Extra.
HAEMOGLOBINOPATHIES Objectives: normal structure and function of haemoglobin. how the globin components of haemoglobin change during development, and postnatally. the mechanisms by which the thalassaemias
More informationHaemoglobinopathy Case Studies. Dr Jill Finlayson Department of Haematology Pathwest Laboratory Medicine
Haemoglobinopathy Case Studies Dr Jill Finlayson Department of Haematology Pathwest Laboratory Medicine Case 1 KB, 36y M Refugee Afghanistan Screening bloods Hb 101 g/l RCC 3.75 x10 12 /L MCV 90 fl MCH
More informationSome Observations on Haemoglobin A 2
Some Observations on Haemoglobin A 2 Barbara J Bain St Mary s Hospital and Imperial College London Image from www.dsc.discovery.com Haemoglobin A 2 5 HBE1 HBG2 HBG1 HBD HBB LCRB ε G γ A γ ψβ δ β 3 5 LCRA
More informationHeme Questions and Derivatives for the USMLE Step One Exam. Winter Storm Skylar Edition
Heme Questions and Derivatives for the USMLE Step One Exam Winter Storm Skylar Edition Howard J. Sachs, MD Howard@12DaysinMarch.com www.12daysinmarch.com Patient presents for routine preoperative evaluation
More informationHow to Write a Life Care Plan for a Child with Hemoglobinopathy
How to Write a Life Care Plan for a Child with Hemoglobinopathy Tamar Fleischer, BSN, MSN, CNLCP & Mona Yudkoff, RN, MPH, CRRN, CNLCP BalaCare Solutions March 2018 St. Peterburg, Florida What is Hemoglobinopathy?
More informationLecture 5. Dr. Sameh Sarray Hlaoui
Lecture 5 Myoglobin & Hemoglobin Dr. Sameh Sarray Hlaoui Myoglobin and Hemoglobin Myoglobin - Myoglobin and Hemoglobin are (metalloprotein containing a heme prosthetic group). hemeproteins - Function as
More informationCongenital Haemoglobinopathies
Congenital Haemoglobinopathies L. DEDEKEN, MD H O P I T A L U N I V E R S I T A I R E D E S E N F A N T S R E I N E F A B I O L A U N I V E R S I T E L I B R E DE B R U X E L L E S Red Blood Cell Disorders
More informationGeneral Characterisctics
Anemia General Characterisctics Definition: anemia is a decrease in red blood cells. Happens due to underproduction, increased destruction or loss of red cells. Diagnosis of anemia: Hgb < 135 (men) Hgb
More information79 Hemoglobinopathies: The How, Why and What. James Hoyer MD
79 Hemoglobinopathies: The How, Why and What James Hoyer MD 2011 Annual Meeting Las Vegas, NV AMERICAN SOCIETY FOR CLINICAL PATHOLOGY 33 W. Monroe, Ste. 1600 Chicago, IL 60603 79 Hemoglobinopathies: The
More informationExtra Notes 3. Warm. In the core (center) of the body, where the temperature is 37 C.
Extra Notes 3 *The numbers of the slides are according to the last year slides. Slide 33 Autoimmune hemolytic anemia : Abnormal circulating antibodies that target normal antigen on the RBC and cause lysis.
More informationKJLM. Comparison of Capillary Electrophoresis with Cellulose Acetate Electrophoresis for the Screening of Hemoglobinopathies INTRODUCTION
Korean J Lab Med 2011;31:238-243 Original Article Diagnostic Hematology Comparison of Capillary Electrophoresis with Cellulose Acetate Electrophoresis for the Screening of Hemoglobinopathies Ji-Eun Kim,
More informationCorporate Medical Policy
Corporate Medical Policy Genetic Testing for Alpha Thalassemia File Name: Origination: Last CAP Review: Next CAP Review: Last Review: genetic_testing_for_alpha_thalassemia 9/2013 7/2017 7/2018 7/2017 Description
More informationWhat is Thalassaemia?
What is Thalassaemia? Introduction The thalassaemias are a diverse group of genetic blood diseases characterized by absent or decreased production of normal hemoglobin, resulting in a microcytic anemia
More informationGeorge R. Honig Junius G. Adams III. Human Hemoglobin. Genetics. Springer-Verlag Wien New York
George R. Honig Junius G. Adams III Human Hemoglobin Genetics Springer-Verlag Wien New York George R. Honig, M.D., Ph.D. Professor and Head Department of Pediatrics, College of Medicine University of Illinois
More informationSeroprevalence of Sickle Cell Anemia And Thalassemia in Suspected Case of Genetic Disorders in Tribal Predominant Population, Ranchi,India
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 16, Issue 3 Ver. X (March. 2017), PP 55-62 www.iosrjournals.org Seroprevalence of Sickle Cell Anemia
More informationResearch Article Pattern of β-thalassemia and Other Haemoglobinopathies: A Cross-Sectional Study in Bangladesh
International Scholarly Research Network ISRN Hematology Volume 2012, Article ID 659191, 6 pages doi:10.5402/2012/659191 Research Article Pattern of β-thalassemia and Other Haemoglobinopathies: A Cross-Sectional
More informationThalassemia intermedia in HbH-CS disease with compound heterozygosity for β-thalassemia: Challenges in hemoglobin analysis and clinical diagnosis
Genes Genet. Syst. (2009) 84, p. 67 71 Thalassemia intermedia in HbH-CS disease with compound heterozygosity for β-thalassemia: Challenges in hemoglobin analysis and clinical diagnosis Jin Ai Mary Anne
More informationHEMOGLOBINOPATHIES LECTURE OUTLINE. An overview of the structure of hemoglobin. Different types of hemoglobin. Definition of hemoglobinopathies
Slide 1 HEOGLOBINOPATHIES Slide 2 LETURE OUTLINE An overview of the structure of hemoglobin. Different types of hemoglobin. Definition of hemoglobinopathies Sickle ell Disease and Hemoglobin Slide 3 HEOGLOBIN
More informationDisclosure. Hemoglobinopathies. Screening for Hemoglobinopthies. Learning Objectives. Screening for Hemoglobinopthies. Interpreting Reports
Disclosure Hemoglobinopathies (everything you wanted to know but were afraid to ask) Melissa Frei-Jones, MD MSCI Pediatric Grand Rounds February 21, 2014 I have no relationships with commercial companies
More informationDr Banu Kaya Consultant Haematologist Barts Health NHS Trust Royal London Hospital, London, UK SICKLE CELL AND THALASSAEMIA OVERVIEW
Dr Banu Kaya Consultant Haematologist Barts Health NHS Trust Royal London Hospital, London, UK SICKLE CELL AND THALASSAEMIA OVERVIEW Objectives Gain awareness of haemoglobinopathy inheritance, pathophysiology
More informationType and frequency of hemoglobinopathies, diagnosed in the area of Karachi, in Pakistan
HEMATOLOGY RESEARCH ARTICLE Type and frequency of hemoglobinopathies, diagnosed in the area of Karachi, in Pakistan Received: 09 March 2016 Accepted: 09 May 2016 First Published: 13 May 2016 *Corresponding
More informationHematologic Features of Alpha Thalassemia Carriers
IJMCM Summer 2012, Vol 1, No 3 Original Article Hematologic Features of Alpha Thalassemia Carriers Haleh Akhavan-Niaki 1,2, Reza Youssefi Kamangari 2, Ali Banihashemi 2, Vahid Kholghi Oskooei 1, Mandana
More informationLaboratory for diagnosis of THALASSEMIA
SCBM343 CLINICAL PATHOLOGY 2(1-2-3) Laboratory for diagnosis of THALASSEMIA PORNTHIP CHAICHOMPOO pornthip.chh@mahidol.ac.th Acknowledgements Dr. Pranee Winichagoon Fucharoen Ms. Pornnapa Khampan Thalassemia
More informationPOLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY
Original Issue Date (Created): November 26, 2013 Most Recent Review Date (Revised): November 26, 2013 Effective Date: April 1, 2014 POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS
More informationJournal of Medical Science & Technology
Page82 Original Article Journal of Medical Science & Technology Open Access Screening for hemoglobinopathies among patients in a government hospital and health clinics in Perlis, Malaysia Chin Yuet Meng
More informationHypochromic Anaemias
Hypochromic Anaemias Dr Mere Kende MBBS, MMED (Path), MAACB, MACTM, MACRRM LECTURER-SMHS Anaemia LOW HEMOGLOBIN Anaemia Definition: Hb
More informationEpidemiology, Care and Prevention of Hemoglobinopathies
Epidemiology, Care and Prevention of Hemoglobinopathies Nasir Al-Allawi MBChB, PhD. Professor of Hematology College of Medicine University of Dohuk, IRAQ From Research to Practice Training Course in Sexual
More informationIdentification of Haemoglobinopathies by LC/MS
Identification of Haemoglobinopathies by LC/ Mark Harrison; Senior Scientist, ThermoFisher Scientific Sarah Battle; Senior Biomedical Scientist, Royal Hallamshire Hospital Introduction There are over 2
More informationHAEMATOLOGY CASE STUDIES SICKLE CELL SS
OPEN EDUCATIONAL RESOURCES @ DE MONTFORT UNIVERSITY, Leicester UK HAEMATOLOGY CASE STUDIES SICKLE CELL SS Here are a series of diagnostic case studies comparing normal neonate and adult haematology results
More informationSickle cell disease. Fareed Omar 10 March 2018
Sickle cell disease Fareed Omar 10 March 2018 Physiology Haemoglobin structure HbA2: 2α and 2δ chains (2-3%) HbF: 2α and 2γ chains (
More informationFUNCTIONS OF HEMOGLOBIN:
HEMOGLOBIN: Conjugated protein Simple protein combined with a non-protein substance Hemoglobin HEME +GLOBIN nonprotein substance HEME( prosthetic group) Red colour of blood is due to Hb in RBCs Normal
More informationRBCs Disorders 2. Dr. Nabila Hamdi MD, PhD
RBCs Disorders 2 Dr. Nabila Hamdi MD, PhD ILOs Discuss the classification of anemia into hypochromic-microcytic, normochromicnormocytic and macrocytic. Categorize laboratory test procedures used in the
More informationThe Beats of Natural Sciences Issue 3-4 (September-December) Vol. 3 (2016)
Frequency of β (Beta Thalassaemia) Trait and Haemaglobin E (HbE) Trait: Case Study in a Thalassaemia Carrier Detection Camp in Gurudas College, West Bengal, India Mitu De Department of Botany, Gurudas
More informationA Reliable Screening Protocol for Thalassemia and Hemoglobinopathies in Pregnancy An Alternative Approach to Electronic Blood Cell Counting
Hematopathology / SCREENING FOR THALASSEMIA AND HEMOGLOBINOPATHIES IN PREGNANCY A Reliable Screening Protocol for Thalassemia and Hemoglobinopathies in Pregnancy An Alternative Approach to Electronic Blood
More informationLine Probe Assay for Detection of Alpha Thalassemia: A Pilot Study
Line Probe Assay for Detection of Alpha Thalassemia: A Pilot Study Menon PK *, Nimmakayalu M, Bylappa SK, Kumar M, Abdalhaleem HM Center for Advanced Biomedical Research and Innovation, Gulf Medical University,
More informationSickle Cell Disease and impact on the society
Sickle Cell Disease and impact on the society Professor Z.A.Jeremiah Ph.D, FRCPath (London) Professor of Haematology and Blood Transfusion Science Niger Delta University, Wilberforce Island Outline What
More informationb-globin Gene Cluster Haplotypes in Sickle Cell Patients From Southwest Iran
American Journal of Hematology 74:156 160 (2003) b-globin Gene Cluster Haplotypes in Sickle Cell Patients From Southwest Iran Z. Rahimi, 1 M. Karimi, 2 M. Haghshenass, 2 and A. Merat 1 * 1 Department of
More informationDefining HbA1c: the indispensable decision to approach measurement standardization
Defining HbA1c: the indispensable decision to approach measurement standardization Jan-Olof Jeppsson IFCC WG for HbA1c standardization Clinical Chemistry, Malmö University Hospital Sweden 6 November, 2007
More informationTHALASSEMIA AND COMPREHENSIVE CARE
1 THALASSEMIA AND COMPREHENSIVE CARE Melanie Kirby MBBS, FRCP (C), Hospital for Sick Children, Toronto Associate Professor of Paediatrics, University of Toronto. Objectives 2 By the end of this presentation,
More informationUse of mathematical indices based on CBC data to identify patients with β thalassemia minor
Revista Română de Medicină de Laborator Vol. 8, Nr. 3, Septembrie 27 7 Use of mathematical indices based on CBC data to identify patients with β thalassemia minor Trefor Higgins *, Yann Brierley 2, Annu
More informationO 2 O 2 O 2. Haemoglobin
O 2 O 2 O 2 Haemoglobin O 2 O 2 O 2 98% travels in oxyhaemoglobin (in red blood cells) 2% is dissolved in plasma (compared to carbon dioxide, oxygen is relatively insoluble in plasma) O 2 is not very soluble
More information