M. Ahmed et al., The beta-globin genotype E121Q/W15X (cd121GAA -> CAA/cd15TGG -> TGA) underlines Hb D/beta-(0) thalassaemia marked by domination of haemoglobin D, ANN HEMATOL, 80(11), 2001, pp. 629-633
Among 13,525 haemoglobin analyses performed in our laboratory we detected 2
1 cases of haemoglobin D (Hb D) disease. Investigation of a family affected
with this abnormal haemoglobin revealed two cases of Hb D/beta-(0) thalass
aemia for the first time among Saudi Arabs. The two patients were diagnosed
as having chronic haemolytic anaemia of moderate severity on the basis of
the haemoglobin level. haematocrit, mean corpuscular haemoglobin, mean corp
uscular volume, reticulocyte count, red blood cell count microscopy, elevat
ed serum conjugated and non-conjugated bilirubin, increased serum lactic de
hydrogenase, and the occasional need for blood transfusions. Genetic analys
is enabled the detection of compound heterozygosity for the missense E121Q
(codon 121 GAA-->CAA) and stop W15X (codon 15 TGG-->TGA) mutations as causa
tive of the clinical phenotype of Hb D-LosAngeles (Punjab)/beta-(0) thalass
aemia. The disease manifested as domination of Hb D and moderate haemolytic
anaemia. The co-inheritance of beta-(0) thalassaemia seems to be responsib
le for conferring the deleterious effect on the presentation of Hb D diseas
e in these patients. The present result emphasizes the significance of mole
cular testing in resolving certain diagnostic ambiguities in haematology as
in cases of heterozygous Hb D in association with beta-(0) thalassaemia wh
ich, by haemoglobin electrophoresis, may be misdiagnosed as Hb D homozygosi
ty.