Persistent iron and folate deficiency in a patient with deletional hereditary persistence of fetal hemoglobin; the effect on the relative levels of Hb F and G gamma chains and the corresponding mRNAs.
We describe a Black female who has suffered for many years from an (often) severe anemia (Hb 5-9 g/dl) with iron deficiency (serum Fe 8 microg/dl; TIBC 462 microg/dl; ferritin 7 ng/ml or less) and folate deficiency. The patient had hypermenorrhea which was appropriately treated resulting in an increase in hemoglobin level but not affecting the Fe deficiency. Splenomegaly was present, perhaps resulting from a clay-eating habit, although this was consistently denied. The patient had an alpha-thalassemia-2 (-3.7 kb) trait and a deletional hereditary persistence of fetal hemoglobin (HPFH) (type II) which were inherited from her father. Over the last six years the level of Hb F varied between 8.5 and 16% (25-29% in the father), while the G gamma value was also low (15-22% versus 32-34% in the father). Comparable reductions were seen in the relative levels of gamma-mRNA and G gamma-mRNA. These data support results published by Adams et al who showed a severe reduction in Hb F level in another HPFH heterozygote with Fe deficiency; these investigations suggested that a reduction in alpha-globin synthesis resulted in preferential formation of alpha beta dimers rather than alpha gamma dimers. Our data suggest that the decrease of Hb F and G gamma levels is due to a reduction in gamma-mRNA formation, mainly of the G gamma type, rather than through a posttranslational mechanism alone.
Landman
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Obstetrics-Gynecology, St. Elizabeth Hospital Curaçao, The Netherlands Antilles.
Huisman
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TH
D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000235:genetics*; D005260:Female; D005319:Fetal Hemoglobin / Q000235:genetics* / Q000378:metabolism; D005494:Folic Acid Deficiency / Q000097:blood / Q000235:genetics*; D017353:Gene Deletion; D006580:Genetic Carrier Screening; D005914:Globins / Q000235:genetics* / Q000378:metabolism; D006801:Humans; D010842:Pica; D012333:RNA, Messenger / Q000097:blood / Q000378:metabolism*; D017085:alpha-Thalassemia / Q000097:blood / Q000235:genetics
D012333:RNA, Messenger; D005914:Globins; D005319:Fetal Hemoglobin