Prevalence Rate of Thalassemia Carriers among Individuals with Microcytosis or Hypochromia in Portugal

Authors

  • Daniela Santos Department of Human Genetics. Instituto Nacional de Saúde Doutor Ricardo Jorge. Lisbon.
  • Marta Barreto Department of Epidemiology. Instituto Nacional de Saúde Doutor Ricardo Jorge. Lisbon; Centro de Investigação em Saúde Pública. Escola Nacional de Saúde Pública. Universidade NOVA de Lisboa. Lisbon.
  • Irina Kislaya Department of Epidemiology. Instituto Nacional de Saúde Doutor Ricardo Jorge. Lisbon; Centro de Investigação em Saúde Pública. Escola Nacional de Saúde Pública. Universidade NOVA de Lisboa. Lisbon.
  • Joana Mendonça Department of Human Genetics. Instituto Nacional de Saúde Doutor Ricardo Jorge. Lisbon.
  • Miguel P. Machado Department of Human Genetics. Instituto Nacional de Saúde Doutor Ricardo Jorge. Lisbon.
  • Pedro Lopes Department of Human Genetics. Instituto Nacional de Saúde Doutor Ricardo Jorge. Lisbon.
  • Carlos Matias Dias Department of Epidemiology. Instituto Nacional de Saúde Doutor Ricardo Jorge. Lisbon; Centro de Investigação em Saúde Pública. Escola Nacional de Saúde Pública. Universidade NOVA de Lisboa. Lisbon.
  • Paula Faustino Department of Human Genetics. Instituto Nacional de Saúde Doutor Ricardo Jorge. Lisbon; Instituto de Saúde Ambiental. Faculdade de Medicina. Universidade de Lisboa. Lisbon. https://orcid.org/0000-0002-6269-4867

DOI:

https://doi.org/10.20344/amp.19162

Keywords:

Erythrocytes, Erythrocyte Indices, Hematologic Tests, Portugal, Thalassemia/diagnosis, Thalassemia/genetics

Abstract

Introduction: Microcytosis and hypochromia result from deficient hemoglobin synthesis in red blood cells and are easily detected in a complete blood count test. These conditions are mainly due to iron nutritional deficiency, but may also result from some genetic diseases, such as thalassemia. The aim of this study was to determine the contribution of β- and α-thalassemia to these abnormal hematological phenotypes in a representative sample of adult individuals living in Portugal who participated in the first Portuguese National Health Examination Survey (INSEF).
Methods: Among the 4808 INSEF participants, 204 had microcytosis, hypochromia or both. The corresponding 204 DNAs were screened for changes in the β-globin gene by next-generation sequencing and Sanger sequencing. In addition, α-thalassemia deletions within the α-globin cluster were investigated by Gap-PCR and multiplex ligation-dependent probe amplification.
Results: In this selected subgroup of INSEF participants, 54 had α-thalassemia (26%), predominantly caused by the -α3.7kb deletion, and 22 were β-thalassemia carriers (11%) mainly due to point mutations in the β-globin gene previously known in Portugal.
Conclusion: Thalassemia trait is a frequent cause of microcytosis or hypochromia in Portugal since this genetic condition was found in 37% of the investigated cases.

 

 

Downloads

Download data is not yet available.

References

World Health Organization. Worldwide prevalence of anaemia 1993-2005. 2020. [cited 2023 Jan 25]. Available from: https://www.who.int/publications/i/item/9789241596657.

Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L. Iron deficiency anaemia. Lancet. 2016;387:907-16. DOI: https://doi.org/10.1016/S0140-6736(15)60865-0

Fonseca C, Marques F, Robalo Nunes A, Belo A, Brilhante D, Cortez J. Prevalence of anaemia and iron deficiency in Portugal: The EMPIRE Study. Intern Med J. 2016;46:470-8. DOI: https://doi.org/10.1111/imj.13020

Higgs DR, Engel JD, Stamatoyannopoulos G. Thalassaemia. Lancet. 2012;379:373-83. DOI: https://doi.org/10.1016/S0140-6736(11)60283-3

Weatherall DJ, Clegg JB. Inherited haemoglobin disorders: an increasing global health problem. Bull World Health Organ. 2001;79:704-12.

Modell B, Darlison M, Birgens H, Cario H, Faustino P, Giordano PC, et al. Epidemiology of haemoglobin disorders in Europe: an overview. Scand J Clin Lab Invest. 2007;67:39-69. DOI: https://doi.org/10.1080/00365510601046557

Peres MJ, Romão L, Carreiro H, Picanço I, Batalha L, Magalhães HA, et al. Molecular basis of alpha-thalassemia in Portugal. Hemoglobin. 1995;19:343-52. DOI: https://doi.org/10.3109/03630269509005826

Martins MC, Olim G, Melo J, Magalhães HA, Rodrigues MO. Hereditary anaemias in Portugal: epidemiology, public health significance, and control. J Med Genet. 1993;30:235-9. DOI: https://doi.org/10.1136/jmg.30.3.235

Inez F, Sequeira M, Santos P, Santos R, Nunes E, Cavaco A, et al. Contribuição do rastreio de portadores para a prevenção da beta-talassémia e da drepanocitose na população portuguesa: um estudo multicêntrico. Arq Inst Nac Saúde. 1993;19:27–31.

Bento C, Relvas L, Vazão H, Campos J, Rebelo U, Ribeiro ML. The use of capillary blood samples in a large scale screening approach for the detection of beta-thalassemia and hemoglobin variants. Haematologica. 2006;91:1565.

Direção-Geral da Saúde. Prevenção das formas graves de hemoglobinopatia: circular normativa nº 18/DSMIA, de 07/09/2004. Lisboa: DGS; 2004.

Nunes B, Barreto M, Gil AP, Kislaya I, Namorado S, Antunes L, et al. The first Portuguese National Health Examination Survey (2015): design, planning and implementation. J Public Health. 2019;41:511-7. DOI: https://doi.org/10.1093/pubmed/fdy150

World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. 2011. [cited 2022 Sep 05]. Available from: https://apps.who.int/iris/handle/10665/85839.

Direção-Geral da Saúde. Abordagem, diagnóstico e tratamento da ferropénia no adulto. Norma 030/2013, de 31/12/2013, atualizada em 09/04/2015. Lisboa: DGS; 2015.

Howe KL, Achuthan P, Allen J, Allen J, Alvarez-Jarreta J, Amode MR, et al. Ensembl 2021. Nucleic Acids Res. 2021;49:D884–91. DOI: https://doi.org/10.1093/nar/gkaa942

Dodé C, Krishnamoorthy R, Lamb J, Rochette J. Rapid analysis of -α3.7 thalassaemia and αααanti3.7 triplication by enzymatic amplification analysis. Br J Haematol. 1993;83:105-11. DOI: https://doi.org/10.1111/j.1365-2141.1993.tb04639.x

Harteveld CL, Higgs DR. Alpha-thalassaemia. Orphanet J Rare Dis. 2010;5:13. DOI: https://doi.org/10.1186/1750-1172-5-13

Harteveld CL, Voskamp A, Phylipsen M, Akkermans N, den Dunnen JT, White SJ, et al. Nine unknown rearrangements in 16p13.3 and 11p15.4 causing α and β thalassaemia characterised by high resolution multiplex ligation-dependent probe amplification. J Med Genet. 2005;42:922-31. DOI: https://doi.org/10.1136/jmg.2005.033597

Faustino P, Pacheco P, Loureiro P, Nogueira PJ, Lavinha J. The geographic pattern of beta-thalassaemia mutations in the Portuguese population. Br J Haematol. 1999;107:903-4. DOI: https://doi.org/10.1046/j.1365-2141.1999.01821.x

Samões C, Kislaya I, Sousa-Uva M, Gaio V, Faustino P, Nunes B. Prevalence of anemia in the Portuguese adult population: results from the first National Health Examination Survey (INSEF 2015). J Public Health. 2022;30:1033-40. DOI: https://doi.org/10.1007/s10389-020-01373-1

Pearson HA, Ehrenkranz RA, Rinder HM, Riely CA. Hemosiderosis in a normal child secondary to oral iron medication. Pediatrics. 2000;105:429-31. DOI: https://doi.org/10.1542/peds.105.2.429

Galanello R, Cao A. Gene test review. Alpha-thalassemia. Genet Med. 2011;13:83-8. DOI: https://doi.org/10.1097/GIM.0b013e3181fcb468

Cao A, Galanello R. Beta-thalassemia. Genet Med. 2010;12:61-76. DOI: https://doi.org/10.1097/GIM.0b013e3181cd68ed

Ropero P, González Fernández FA, Nieto JM, Torres-Jiménez WM, Benavente C. β-Thalassemia intermedia: interaction of α-globin gene triplication with β-thalassemia heterozygous in Spain. Front Med. 2022;9:866396. DOI: https://doi.org/10.3389/fmed.2022.866396

Hoffmann JJ, Urrechaga E. Verification of 20 mathematical formulas for discriminating between iron deficiency anemia and thalassemia trait in microcytic anemia. Lab Med. 2020;51:628-34. DOI: https://doi.org/10.1093/labmed/lmaa030

Jayabose S, Giamelli J, Levondoglu Tugal O, Sandoval C, Ozkaynak F, Visintainer P. Differentiating iron deficiency anemia from thalassemia minor by using an RDW-based index. J Pediatr Hematol Oncol. 1999;21:314. DOI: https://doi.org/10.1097/00043426-199907000-00040

Al-Numan AH, Al-Obeidi RA. The value of the red cell distribution width index versus other parameters in the differentiation between iron deficiency anemia and beta thalassemia trait among children in Mosul, Iraq. Expert Rev Hematol. 2021;14:401-6. DOI: https://doi.org/10.1080/17474086.2021.1905514

Bachir D, Galacteros F. Hemoglobin C disease. 2004. [cited 2022 Sep 12]. Available from: http://www.orpha.net/data/patho/GB/uk-HbC.pdf.

Kountouris P, Lederer CW, Fanis P, Feleki X, Old J, Kleanthous M. IthaGenes: an interactive database for haemoglobin variants and epidemiology. PLoS ONE. 2014;9:e103020. DOI: https://doi.org/10.1371/journal.pone.0103020

Downloads

Published

2023-03-10

How to Cite

1.
Santos D, Barreto M, Kislaya I, Mendonça J, P. Machado M, Lopes P, Matias Dias C, Faustino P. Prevalence Rate of Thalassemia Carriers among Individuals with Microcytosis or Hypochromia in Portugal. Acta Med Port [Internet]. 2023 Mar. 10 [cited 2024 Nov. 22];36(7-8):467-74. Available from: https://actamedicaportuguesa.com/revista/index.php/amp/article/view/19162