Glycosylated Hemoglobin Assay

Total Page:16

File Type:pdf, Size:1020Kb

Glycosylated Hemoglobin Assay Food and Drug Administration, HHS § 864.7525 blood as an aid in the diagnosis of car- a patient. Elevated levels of bon monoxide poisoning. This measure- glycosylated hemoglobin indicate un- ment may be made using methods such controlled diabetes in a patient. as spectroscopy, colorimetry, (b) Classification. Class II (perform- spectrophotometry, and gasometry. ance standards). (b) Classification. Class II (perform- ance standards). [45 FR 60621, Sept. 12, 1980] [45 FR 60619, Sept. 12, 1980] § 864.7490 Sulfhemoglobin assay. § 864.7440 Electrophoretic hemoglobin (a) Identification. A sulfhemoglobin analysis system. assay is a device consisting of the re- (a) Identification. An electrophoretic agents, calibrators, controls, and in- hemoglobin analysis system is a device strumentation used to determine the that electrophoretically separates and sulfhemoglobin (a compound of sulfur identifies normal and abnormal hemo- and hemoglobin) content of human globin types as an aid in the diagnosis blood as an aid in the diagnosis of of anemia or erythrocytosis (increased sulfhemoglobinemia (presence of total red cell mass) due to a hemo- sulfhemoglobin in the blood due to globin abnormality. drug administration or exposure to a (b) Classification. Class II (perform- poison). This measurement may be ance standards). made using methods such as spectros- [45 FR 60620, Sept. 12, 1980] copy, colorimetry, spectrophotometry, or gasometry. § 864.7455 Fetal hemoglobin assay. (b) Classification. Class II (perform- (a) Identification. A fetal hemoglobin ance standards). assay is a device that is used to deter- [45 FR 60621, Sept. 12, 1980] mine the presence and distribution of fetal hemoglobin (hemoglobin F) in red § 864.7500 Whole blood hemoglobin as- cells or to measure the amount of fetal says. hemoglobin present. The assay may be (a) Identification. A whole blood he- used to detect fetal red cells in the ma- moglobin assay is a device consisting ternal circulation or to detect the ele- or reagents, calibrators, controls, or vated levels of fetal hemoglobin exhib- photometric or spectrophotometric in- ited in cases of hemoglobin abnormali- strumentation used to measure the he- ties such as thalassemia (a hereditary hemolytic anemia characterized by a moglobin content of whole blood for decreased synthesis of one or more the detection of anemia. This generic types of hemoglobin polypeptide device category does not include auto- chains). The hemoglobin determination mated hemoglobin systems. may be made by methods such as elec- (b) Classification. Class II (perform- trophoresis, alkali denaturation, col- ance standards). umn chromatography, or radial [45 FR 60622, Sept. 12, 1980] immunodiffusion. (b) Classification. Class II (perform- § 864.7525 Heparin assay. ance standards). (a) Identification. A heparin assay is a [45 FR 60620, Sept. 12, 1980] device used to determine the level of the anticoagulant heparin in the pa- § 864.7470 Glycosylated hemoglobin tient’s circulation. These assays are assay. quantitative clotting time procedures (a) Identification. A glycosylated he- using the effect of heparin on activated moglobin assay is a device used to coagulation factor X (Stuart factor) or measure the glycosylated hemoglobins procedures based on the neutralization (A1a, A1b, and A1c) in a patient’s blood of heparin by protamine sulfate (a pro- by a column chromatographic proce- tein that neutralizes heparin). dure. Measurement of glycosylated he- (b) Classification. Class II (perform- moglobin is used to assess the level of ance standards). control of a patient’s diabetes and to determine the proper insulin dosage for [45 FR 60623, Sept. 12, 1980] 241 VerDate Mar<15>2010 12:50 Apr 27, 2011 Jkt 223072 PO 00000 Frm 00251 Fmt 8010 Sfmt 8010 Y:\SGML\223072.XXX 223072 WReier-Aviles on DSKGBLS3C1PROD with CFR.
Recommended publications
  • Non-Commercial Use Only
    only use Non-commercial 14th International Conference on Thalassaemia and Other Haemoglobinopathies 16th TIF Conference for Patients and Parents 17-19 November 2017 • Grand Hotel Palace, Thessaloniki, Greece only use For thalassemia patients with chronic transfusional iron overload... Make a lasting impression with EXJADENon-commercial film-coated tablets The efficacy of deferasirox in a convenient once-daily film-coated tablet Please see your local Novartis representative for Full Product Information Reference: EXJADE® film-coated tablets [EU Summary of Product Characteristics]. Novartis; August 2017. Important note: Before prescribing, consult full prescribing information. iron after having achieved a satisfactory body iron level and therefore retreatment cannot be recommended. ♦ Maximum daily dose is 14 mg/kg body weight. ♦ In pediatric patients the Presentation: Dispersible tablets containing 125 mg, 250 mg or 500 mg of deferasirox. dosing should not exceed 7 mg/kg; closer monitoring of LIC and serum ferritin is essential Film-coated tablets containing 90 mg, 180 mg or 360 mg of deferasirox. to avoid overchelation; in addition to monthly serum ferritin assessments, LIC should be Indications: For the treatment of chronic iron overload due to frequent blood transfusions monitored every 3 months when serum ferritin is ≤800 micrograms/l. (≥7 ml/kg/month of packed red blood cells) in patients with beta-thalassemia major aged Dosage: Special population ♦ In moderate hepatic impairment (Child-Pugh B) dose should 6 years and older. ♦ Also indicated for the treatment of chronic iron overload due to blood not exceed 50% of the normal dose. Should not be used in severe hepatic impairment transfusions when deferoxamine therapy is contraindicated or inadequate in the following (Child-Pugh C).
    [Show full text]
  • Fetal and Embryonic Haemoglobins P
    Review Article J Med Genet: first published as 10.1136/jmg.10.1.50 on 1 March 1973. Downloaded from Journal of Medical Genetics (1973). 10, 50. Fetal and Embryonic Haemoglobins P. A. LORKIN MRC Abnormal Haemoglobin Unit, University Department of Biochemistry, Cambridge Haemoglobin has been the subject of intensive form a nearly spherical molecule with extensive research for many years and is one of the most areas of contact between unlike chains; the two thoroughly understood of all protein molecules. main types of contact are denoted alp, and alg2 The amino-acid sequences of haemoglobins from The tetramer exhibits cooperative behaviour or many species of animals have been determined haem-haem interaction. As each haem combines (tabulated by Dayhoff, 1969) and the molecular with oxygen the affinity of successive haems in- structures of horse and human haemoglobins have creases. The oxygen affinity curve of the tetramer been determined in great detail by x-ray crystallo- is sigmoidal and may be represented approximately graphy (Perutz et al, 1968a and b; Perutz 1969). A by the Hill equation:* mechanism of action of haemoglobin has been pro- = kpo2n posed (Perutz, 1970a and b and 1972). The y haemoglobins of higher organisms share a common +kpo2n tetrameric structure built up of two pairs of unlike Oxygen affinity data are usually presented in copyright. chains; the a chains containing 141 amino-acid terms of P102, the partial pressure of oxygen re- residues and the non-a chains containing generally quired to attain half saturation with oxygen, and of 145 or 146 amino acids. In man, five types of n, the exponent of the Hill equation.
    [Show full text]
  • ATSDR Case Studies in Environmental Medicine Nitrate/Nitrite Toxicity
    ATSDR Case Studies in Environmental Medicine Nitrate/Nitrite Toxicity Agency for Toxic Substances and Disease Registry Case Studies in Environmental Medicine (CSEM) Nitrate/Nitrite Toxicity Course: WB2342 CE Original Date: December 5, 2013 CE Expiration Date: December 5, 2015 Key • Nitrate toxicity is a preventable cause of Concepts methemoglobinemia. • Infants younger than 4 months of age are at particular risk of nitrate toxicity from contaminated well water. • The widespread use of nitrate fertilizers increases the risk of well-water contamination in rural areas. About This This educational case study document is one in a series of and Other self-instructional modules designed to increase the primary Case Studies care provider’s knowledge of hazardous substances in the in environment and to promote the adoption of medical Environmen- practices that aid in the evaluation and care of potentially tal Medicine exposed patients. The complete series of Case Studies in Environmental Medicine is located on the ATSDR Web site at URL: http://www.atsdr.cdc.gov/csem/csem.html In addition, the downloadable PDF version of this educational series and other environmental medicine materials provides content in an electronic, printable format. Acknowledgements We gratefully acknowledge the work of the medical writers, editors, and reviewers in producing this educational resource. Contributors to this version of the Case Study in Environmental Medicine are listed below. Please Note: Each content expert for this case study has indicated that there is no conflict of interest that would bias the case study content. CDC/ATSDR Author(s): Kim Gehle MD, MPH CDC/ATSDR Planners: Charlton Coles, Ph.D.; Kimberly Gehle, MD; Sharon L.
    [Show full text]
  • ZNF410 Represses Fetal Globin by Devoted Control of CHD4/Nurd
    bioRxiv preprint doi: https://doi.org/10.1101/2020.08.31.272856; this version posted August 31, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY-NC-ND 4.0 International license. Title ZNF410 represses fetal globin by devoted control of CHD4/NuRD Authors Divya S. Vinjamur1, Qiuming Yao1,2, Mitchel A. Cole1, Connor McGuckin1, Chunyan Ren1, Jing Zeng1, Mir Hossain1, Kevin Luk3, Scot A. Wolfe3, Luca Pinello2, Daniel E. Bauer1,4 1Division of Hematology/Oncology, Boston Children’s Hospital, Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Stem Cell Institute, Broad Institute, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts 02115, USA 2Molecular Pathology Unit, Center for Cancer Research, and Center for Computational and Integrative Biology, Massachusetts General Hospital, Department of Pathology, Harvard Medical School, Boston, Massachusetts 02129, USA 3Department of Molecular, Cell and Cancer Biology, Li Weibo Institute for Rare Diseases Research, University of Massachusetts Medical School, Worcester, Massachusetts 01605, USA 4Correspondence: [email protected] bioRxiv preprint doi: https://doi.org/10.1101/2020.08.31.272856; this version posted August 31, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY-NC-ND 4.0 International license. Abstract Major effectors of adult-stage fetal globin silencing include the transcription factors (TFs) BCL11A and ZBTB7A/LRF and the NuRD chromatin complex, although each has potential on- target liabilities for rational �-hemoglobinopathy therapeutic inhibition.
    [Show full text]
  • Analysis of Genetic Determinants Associated with Persistent Synthesis of Fetal Hemoglobin
    UNIVERSITÀ DEGLI STUDI DI SASSARI PhD School in Biomolecular and Biotechnological Sciences Curriculum: Biochemistry and Molecular Biology Director: Prof. Claudia Crosio “XXVI Ciclo” Analysis of genetic determinants associated with Persistent Synthesis of Fetal Hemoglobin Supervisor: Monica Pirastru, PhD Director: Prof. Claudia Crosio PhD Student: Sandro Trova ................................................................................................................................................. INDEX INDEX ABSTRACT ................................................................................... 3 INTRODUCTION ......................................................................... 4 1. Hemoglobin .......................................................................................... 4 1.1 Structure and function of Hemoglobin ........................................ 4 1.2 Structure of globin genes and their cluster organization ............. 5 1.3 Genomic context of the α– and β–globin gene clusters .............. 9 2. Globin gene switching ....................................................................... 12 2.1 Regulatory regions and transcription factors of globin genes ... 13 2.2 The β–Globin Locus Control Region (β–LCR) role in globin expression ....................................................................... 20 2.3 Chromatin role in β–like globin gene expression: the PYR role .............................................................................. 25 2.4 Summary on the fetal to adult switch .......................................
    [Show full text]
  • Iron and Chelation in Biochemistry and Medicine: New Approaches to Controlling Iron Metabolism and Treating Related Diseases
    cells Review Iron and Chelation in Biochemistry and Medicine: New Approaches to Controlling Iron Metabolism and Treating Related Diseases George J. Kontoghiorghes * and Christina N. Kontoghiorghe Postgraduate Research Institute of Science, Technology, Environment and Medicine, CY-3021 Limassol, Cyprus * Correspondence: [email protected]; Tel./Fax: +357-2627-2076 Received: 7 May 2020; Accepted: 5 June 2020; Published: 12 June 2020 Abstract: Iron is essential for all living organisms. Many iron-containing proteins and metabolic pathways play a key role in almost all cellular and physiological functions. The diversity of the activity and function of iron and its associated pathologies is based on bond formation with adjacent ligands and the overall structure of the iron complex in proteins or with other biomolecules. The control of the metabolic pathways of iron absorption, utilization, recycling and excretion by iron-containing proteins ensures normal biologic and physiological activity. Abnormalities in iron-containing proteins, iron metabolic pathways and also other associated processes can lead to an array of diseases. These include iron deficiency, which affects more than a quarter of the world’s population; hemoglobinopathies, which are the most common of the genetic disorders and idiopathic hemochromatosis. Iron is the most common catalyst of free radical production and oxidative stress which are implicated in tissue damage in most pathologic conditions, cancer initiation and progression, neurodegeneration and many other diseases. The interaction of iron and iron-containing proteins with dietary and xenobiotic molecules, including drugs, may affect iron metabolic and disease processes. Deferiprone, deferoxamine, deferasirox and other chelating drugs can offer therapeutic solutions for most diseases associated with iron metabolism including iron overload and deficiency, neurodegeneration and cancer, the detoxification of xenobiotic metals and most diseases associated with free radical pathology.
    [Show full text]
  • Research Article Sickle Cell Anemia Patients in Use Of
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Crossref Hindawi Disease Markers Volume 2018, Article ID 6105691, 11 pages https://doi.org/10.1155/2018/6105691 Research Article Sickle Cell Anemia Patients in Use of Hydroxyurea: Association between Polymorphisms in Genes Encoding Metabolizing Drug Enzymes and Laboratory Parameters 1,2 1 Sètondji Cocou Modeste Alexandre Yahouédéhou, Magda Oliveira Seixas Carvalho, 1 1 1 Rodrigo Mota Oliveira, Rayra Pereira Santiago, Caroline Conceição da Guarda, 1 1 1 Suellen Pinheiro Carvalho, Júnia Raquel Dutra Ferreira, Milena Magalhães Aleluia, 2 1,2 Elisângela Vitória Adorno, and Marilda de Souza Gonçalves 1Laboratório de Hematologia, Genética e Biologia Computacional (LHGB), Fiocruz Bahia-Instituto Gonçalo Moniz (IGM), Rua Waldemar Falcão 121, Candeal, 40296-710 Salvador, BA, Brazil 2Laboratório de Pesquisa em Anemia (LPA), Departamento de Análises Clínicas, Faculdade de Farmácia, Universidade Federal da Bahia, Rua Barão do Jeremoabo 147, Ondina, 40170-115 Salvador, BA, Brazil Correspondence should be addressed to Marilda de Souza Gonçalves; mari@bahia.fiocruz.br Received 12 August 2017; Revised 25 November 2017; Accepted 4 December 2017; Published 28 January 2018 Academic Editor: Fabrizia Bamonti Copyright © 2018 Sètondji Cocou Modeste Alexandre Yahouédéhou et al. This 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. This study investigated associations between SNPs in genes encoding metabolizing drug enzymes and laboratory parameters in sickle cell anemia patients under hydroxyurea (SCA-HU+). We evaluated hematologic and biochemical parameters by electronic − methods and SNPs by PCR-RFLP and multiplex PCR in 35 SCA-HU+ patients and 67 SCA-HU patients.
    [Show full text]
  • The Formation of Methemoglobin and Sulfhemoglobin During Sulfanilamide Therapy
    THE FORMATION OF METHEMOGLOBIN AND SULFHEMOGLOBIN DURING SULFANILAMIDE THERAPY J. S. Harris, H. O. Michel J Clin Invest. 1939;18(5):507-519. https://doi.org/10.1172/JCI101064. Research Article Find the latest version: https://jci.me/101064/pdf THE FORMATION OF METHEMOGLOBIN AND SULFHEMOGLOBIN DURING SULFANILAMIDE THERAPY By J. S. HARRIS AND H. 0. MICHEL (From the Departments of Pediatrics and Biochemistry, Duke University School of Medicine, Durham) (Received for publication April 8, 1939) Cyanosis almost invariably follows the admin- during the administration of sulfanilamide. Wen- istration of therapeutic amounts of sulfanilamide del (10) found spectroscopic evidence of met- (1). This cyanosis is associated with and is due hemoglobin in every blood sample containing over to a change in the color of the blood. The dark- 4 mgm. per cent sulfanilamide. Evelyn and Mal- ening of the blood is present only in the red cells loy (11) have found that all patients receiving and therefore must be ascribed to one of two sulfanilamide show methemoglobinemia, although causes, a change in the hemoglobin itself or a the intensity is usually very slight. Finally Hart- staining of the red cells with some product formed mann, Perley, and Barnett (12) found cyanosis during the metabolism of sulfanilamide. It is the associated with methemoglobinemia in almost ev- purpose of this paper to assay quantitatively the ery patient receiving over 0.1 gram sulfanilamide effect of sulfanilamide upon the first of these fac- per kilogram of body weight per day. They be- tors-that is, upon the formation of abnormal lieved that the intensity of the methemoglobinemia heme pigments.
    [Show full text]
  • The Role of Nonhemoglobin Proteins and Reduced Glutathione in the Protection of Hemoglobin from Oxidation in Vitro
    The Role of Nonhemoglobin Proteins and Reduced Glutathione in the Protection of Hemoglobin from Oxidation In Vitro A. S. Hill Jr., … , G. E. Cartwright, M. M. Wintrobe J Clin Invest. 1964;43(1):17-26. https://doi.org/10.1172/JCI104889. Research Article Find the latest version: https://jci.me/104889/pdf Journal of Clinical Investigatiox Vol. 43, No. 1, 1964 The Role of Nonhemoglobin Proteins and Reduced Glutathione in the Protection of Hemoglobin from Oxidation In Vitro * A. S. HILL, JR., A. HAUT, G. E. CARTWRIGHT, AND M. M. WINTROBE (From the Department of Medicine, University of Utah College of Medicine, Salt Lake City, Utah) A deficiency of reduced glutathione in erythro- human erythrocytes by Allen and Jandl (10) led cytes of freshly shed blood (1-4) or in erythro- these authors to conclude that GSH per se pro- cytes exposed to certain chemical compounds (5) tects hemoglobin from oxidation and that no ad- has been associated with shorter red cell survival ditional factors are required; conversely, Szein- and, in most cases, with the accumulation of oxi- berg and Marks (11) found that GSH affords no dation products of hemoglobin, including methe- protection to human hemoglobin against oxidative moglobin, sulfhemoglobin, and Heinz bodies. changes. The earlier report of Foulkes and Studies of "primaquine-sensitive" hemolytic dis- Lemberg (12) that GSH might oxidize hemo- ease have emphasized as a characteristic feature globin, along with the studies by Szeinberg and an "unstable" reduced glutathione (GSH) in the Marks (11) and Allen and Jandl (10), casts red cells, attributed to limited availability of re- doubt on the applicability to humans of the con- duced TPN (TPNH), the result, in turn, of a cept (13, 14), based on studies of rat blood (7, deficiency of the enzyme, glucose-6-phosphate 8), that an adequate amount of reduced glutathi- dehydrogenase - (G6PD).
    [Show full text]
  • Arizona Hemoglobin Bart's Fact Sheet for Health Care Providers
    Arizona Hemoglobin Bart’s Fact Sheet for Health Care Providers Hemoglobin Barts Your patient has been found on the Arizona Newborn Genetic Screen to have a hemoglobin electrophoresis pattern consistent with "FA Bart’s". The acronym stands for the hemoglobin species present in the baby's blood in descending order of prevalence. The F designates fetal hemoglobin (a2 y2), A denotes hemoglobin A (a2ß2) and Bart’s represents hemoglobin Bart's, a tetramer of y-globin molecules (y4). Hemoglobin Barts (y4) appears in the newborn when one or more of the 4 human a-globin genes are missing. The relative over abundance of y-globin molecules leads to y4 production and the diagnosis of Hemoglobin Barts. Alpha thalassemia is caused by deletions of the alpha globin genes on chromosome 16. Normal individuals have 4 copies of the gene with 2 on each chromosome. It is possible to lose 1 to 4 of these genes. The presence of hemoglobin Bart’s on newborn screen usually suggests that the infant is missing at least 1 alpha gene. The silent carrier: One deleted Alpha Gene Neonates and children with three functional alpha genes have a complete or nearly completely silent phenotype. The red cell indices are normal and remain so for life. When only one a gene is non- functional, the hemoglobin Barts percentage is usually 1-2% in the newborn, and is not detectable when the fetal hemoglobin synthesis stops at 6 months of age. As the newborn matures, the red cells can rarely exhibit a reduced MCV, MCH, but will show normal HBA2 and F levels if the hemoglobin electrophoresis is repeated.
    [Show full text]
  • Hemoglobin/Myoglobin Robert F.Diegelmann, Ph.D
    Hemoglobin/Myoglobin Robert F.Diegelmann, Ph.D. OBJECTIVES 1. Describe the interactions of heme, globins and oxygen. 2. Discuss the mechanism responsible for Sickle­Cell Anemia. 3. Understand the clinical significance of A1C hemoglobin. 4. Describe the basic biochemical mechanisms of O2 delivery & CO2 removal. RECOMMENDED RESOURCES Lehninger, Principles of Biochemistry, 5th edition, Chapter 5 Molecular Cell Biology, 5th edition; Lodish et al., page 67 http://web.indstate.edu/thcme/mwking/hemoglobin­myoglobin.html#hemoglobin Myoglobin (muscle) & Hemoglobin (Red Blood Cells) were the first proteins for which three­ dimensional structures were determined. Professor Max Perutz and his colleagues at Cambridge University determined Hemoglobin’s three dimensional structure in the late 1950s Therefore Hemoglobin is one of the most studied & best understood proteins. Figure 1. The Evolution of the Globin protein family Figure 2. Structural similarity of the Globin proteins Figure 3 Below is the basic heme group structure. It consists of a complex organic ring structure named Protoporphyrin. NOTE: Heme metabolism will be covered in more detail in another lecture. Protoporphyrin prosthetic group Porphyrin ring Fe binding site Methene bridge Substitution sites Figure 4 Oxygen is not very soluble in aqueous solutions and therefore needs a special molecule to be carried to tissues and cells. The Protoporphyrin ring structure of Heme binds a single iron atom in its ferrous (Fe 2+) . The iron atom has six coordination bonds, four are found bound to the nitrogens in the Porphyrin ring system and two additional sites perpendicular to the Porphyrin. The Cytochromes (a, b & c) are proteins that also consist of porphyrin structures.
    [Show full text]
  • Research Article Association Between HBA Locus Copy Number Gains And
    INTERNATIONAL JOURNAL OF MEDICAL BIOCHEMISTRY DOI: 10.14744/ijmb.2021.65477 Int J Med Biochem 2021;4(2):91-6 Research Article Association between HBA locus copy number gains and pathogenic HBB gene variants Guven Toksoy1, Nergis Akay2, Agharza Aghayev1, Volkan Karaman1, Sahin Avci1, Tugba Kalayci1, Umut Altunoglu1, Zeynep Karakas2, Zehra Oya Uyguner1 1Department of Medical Genetics, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey 2Department of Pediatric Hematology-Oncology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey Abstract Objectives: Alpha (α) and beta (β) thalassemia are the most prevalent genetic hematological disorders. The co-occur- rence of silent β-thalassemia with excess α-globin gene copies is associated with the thalassemia intermedia pheno- type. This study was an investigation of the α-globulin gene dosage and sequence variations in thalassemia patients. Methods: Multiplex ligation-dependent probe amplification and Sanger sequencing were used to identify the hemo- globin subunit alpha 1 (HBA1) and HBA2 gene alterations in 32 patients. Deletion, duplication, and other findings were analyzed in the index cases and family members. Results: Four of the 32 cases (12.5%) were found to have gross duplications. Two cases demonstrated α-globin triplica- tion, and 2 had a quadruplicated HBA1/2 genes. Affected family members revealed genotype-phenotype correlation. In 1 patient, it was observed that quadruplicated HBA genes co-occurrence with hemoglobin subunit beta (HBB) mu- tation was inherited from his mother. Notably, the mother did not demonstrate any thalassemia phenotype. Further investigation showed that the mother was carrying a single copy HBA gene deletion in the trans allele that explained her clinical condition.
    [Show full text]