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Detection of Abnormal Hemoglobin Variants by HPLC Method: Common Problems with Suggested Solutions

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Detection of Abnormal Hemoglobin Variants by HPLC Method: Common Problems with Suggested Solutions Hindawi Publishing Corporation International Scholarly Research Notices Volume 2015, Article ID 498230, 1 page http://dx.doi.org/10.1155/2015/498230 Retraction Retracted: Detection of Abnormal Hemoglobin Variants by HPLC Method: Common Problems with Suggested Solutions International Scholarly Research Notices Received 14 April 2015; Accepted 14 April 2015 Copyright © 2015 International Scholarly Research Notices. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Tepapertitled“DetectionofAbnormalHemoglobinVari- ants by HPLC Method: Common Problems with Suggested Solutions,” [1] published in International Scholarly Research Notices, has been retracted as it was submitted for publication without the knowledge and approval of one of the coauthors, Dr. Suman Lata Mendiratta. Te submitting author Dr. Dipti Kalita plagiarized data from the Talassemia Control Project headed by Dr. Suman Lata Mendiratta. References [1]L.Pant,D.Kalita,S.Singhetal.,“Detectionofabnormalhemo- globin variants by HPLC method: common problems with sug- gested solutions,” International Scholarly Research Notices,vol. 2014,ArticleID257805,10pages,2014. Hindawi Publishing Corporation International Scholarly Research Notices Volume 2014, Article ID 257805, 10 pages http://dx.doi.org/10.1155/2014/257805 Research Article Detection of Abnormal Hemoglobin Variants by HPLC Method: Common Problems with Suggested Solutions Leela Pant,1 Dipti Kalita,1 Sompal Singh,1 Madhur Kudesia,1 Sumanlata Mendiratta,2 Meenakshi Mittal,2 and Alka Mathur3 1 Department of Pathology, Hindu Rao Hospital, Delhi 110007, India 2 Talassemia Control cell, Hindu Rao Hospital, Delhi, India 3 Department of Pediatrics, Hindu Rao Hospital, Delhi, India Correspondence should be addressed to Dipti Kalita; [email protected] Received 13 April 2014; Accepted 16 July 2014; Published 12 October 2014 Academic Editor: Josep Esteve-Romero Copyright © 2014 Leela Pant et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Talassemia and thalassemic hemoglobinopathies pose serious health problem leading to severe morbidity and mortality in Indian population. Plethora of hemoglobin variants is prevalent in multiethnic Indian population. Te aim of the present study was to analyze laboratory aspects, namely, hematological profle and HPLC fndings of the hemoglobin variants detected, and to discuss problems that we faced in diagnosis in a routine clinical laboratory. We screened a total of 4800 cases in a hospital based population of North India in a 2-years period of by automated HPLC method using the Variant Hemoglobin Testing System (Variant II Beta Talassemia Short Program, Bio-Rad Laboratories) under the experimental conditions specifed by the manufacturer. Whole blood in EDTA was used and red cell indices were determined using automated hematology analyzer. Wedetected 290 cases with abnormal variants in which beta thalassemia was the most common followed by hemoglobin E. Here, we discuss the laboratory aspects of various hemoglobin disorders and diagnostic difculties in cases like borderline HbA2 values, presence of silent mutation, alpha thalassemia gene, and few rare variants which at times require correlation with genetic study. Special attention was given to HbA2 level even in presence of a structural variant to rule out coinheritance of beta thalassemia gene. 1. Introduction clinically signifcant variants. Te simplicity of the automated system with internal sample preparation, superior resolution, Talassemia is an autosomal recessive inherited group of rapid assay time, and accurate quantifcation of hemoglobin disorders of hemoglobin synthesis characterized by the fractions makes this an ideal methodology for the routine absence or reduction of one or more of the globin chains of clinical laboratory [2, 3]. hemoglobin. Te structural variants result from substitution With increasing global awareness and mass screening of one or more amino acids in the globin chains of the programs undertaken at various levels by health care sys- hemoglobin molecule [1]. Plethora of hemoglobin variants is tem, the responsibility for laboratory personnel has greatly prevalentinIndiaowingtoethnicdiversityofitspopulation enhanced in detection and prevention of this problem. with minimal to major clinical signifcance. Being recessively Awareness about the diagnostic problems as well as their inherited from the parents, the thalassemia and thalassemic solutions is very important so that one does not miss a single hemoglobinopathies pose serious health problem leading to case. severe morbidity and mortality in Indian population. Many studies have been published from India on tha- Detection of asymptomatic carriers by reliable laboratory lassemia and thalassemic hemoglobinopathies mostly putting methodsisthecornerstoneofpreventionofthisserious emphasis on epidemiology and screening [4–6]. health problem. Cation exchange high performance liquid Very few studies are available on the approach of diagno- chromatography (CE-HPLC) has become the preferred tech- sis and problems in routine diagnosis, especially in laborato- niquesuitableinIndianscenario,asitcandetectmostofthe ries with limited resources. 2 International Scholarly Research Notices Te aim of the present study was to analyze laboratory Table 1: Distribution of hemoglobin variants. aspects,namely,hematologicalprofleandHPLCfndingsof thehemoglobinvariantsdetected,andtodiscussproblems Hemoglobin variant Number (%) that we faced in diagnosis in a routine clinical laboratory. Beta thalassemia trait (BTT) 216 (74.48) Beta thalassemia intermedia/major (BTI/M) 9 (3.10) 2. Material and Methods Hb E trait (HbAE) 28 (9.65) Hb E disease (HbEE) 2 (0.69) Tis was a prospective study carried out in the Department Hb E beta thalassemia (HbE-BT) 2 (0.69) of Pathology and Talassemia Control Cell, Hindu Rao Hb D trait (HbAD) 15 (5.17) Hospital,Delhi,for2years’period.Atotalof4800cases HbD-beta thalassemia (HbD-BT) 4 (1.38) were screened for presence of thalassemia or any structural HbS trait (HbAS) 9 (3.10) variant. Tese included all cases of microcytic hypochromic Delta beta thalassemia (deltaBTT) 3 (1.03) anaemia (MCV < 80 f, MCH < 27 pg, and RBC count Hb J Meerut 1 (0.34) > 5million/�l) not responding to conventional treatment, clinically suspected cases of hemoglobinopathy, antenatal, Hb Hope 1 (0.34) and other cases coming to the department for thalassemia Total 290 screening. A 5 mL intravenous blood sample was collected in EDTA anticoagulant. Red cell indices were measured on an automated haematology analyzer (Sysmex KX 21). (4) Wash/diluent solution: deionized water. HbA2, HbF,and other haemoglobin variants were studied (5) Control: normal (HbF 1-2%, HbA2 1.8–3.2%) and by HPLC method used for chromatographic separation of abnormal (HbF 5–10%, HbA2 4–6%) controls. human hemoglobin [7–9]. We used the Variant Hemoglobin Testing System (Variant 2.3. Sample Collection and Preparation. Five milliliters II Beta Talassemia Short Program, Bio-Rad Laboratories (5 mL) of whole blood was collected in a vacuum collection Inc., Hercules, CA, USA) under the experimental conditions tube containing EDTA which can be stored at 2–8 degrees C specifed by the manufacturer [10]. for maximum 7 days if processing is delayed. No preparation wasrequiredunlessthesamplewasinatubeotherthanthe 2.1. Principle. TeVariantIIBetaTalassemiaShortPro- recommended tube or there was less than 500 �Lofsample gram utilizes principles of ion-exchange high-performance inthetube.Insuchcase,samplewasmanuallyprediluted. liquid chromatography (HPLC). Te samples are automati- Predilution was carried out by mixing 1.0 mL wash/diluents cally mixed and diluted on the Variant II Sampling Station with 5 �Lofwholebloodsample. (VSS) and injected to the analytical cartridge. Te Variant HbA2/F calibrators and normal and abnormal controls II Chromatographic Station (VCS) dual pumps deliver a were analyzed at the beginning of each run. programmed bufer gradient of increasing ionic strength to the cartridge, where HbA2/F are separated based on their 2.4. Interpretation of Reports. Reports and chromatograms ionic interaction with the cartridge material. Te separated generated were studied and interpreted by observing HbA2 HbA2/F then pass through the fow cell of the flter photome- and F concentration for beta thalassemia and retention ter where the changes in absorbance at 415 nm are measured. time and area percentage of other peaks and windows for An additional flter at 690 nm corrects the background structural variants. Each chromatogram shows peaks of Hb absorbance. Te Variant II CDM (CDM) Sofware performs A0, A2, and Hb F along with C window, D window, S window, reduction of raw data collected from each analysis. To aid in and two minor peaks, P2 and P3. Several hemoglobin variants the interpretation of results, windows have been established elutesamewindow;theywereprovisionallydiagnosedby for the most frequently occurring hemoglobins based on the retention time and area percentage keeping in mind the characteristic retention time. For each sample a sample report ethnicity of the patients. and a chromatogram are generated by CDM showing all Other relevant tests were done, for example, sickling test hemoglobin
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