title: An interplay of alleviating mutations in the clinical phenotype of beta-thalassaemia intermedia.
abstract: Prediction of a beta-thalassaemia major phenotype from the beta-genotype is generally relatively straightforward. However, despite the ability to accurately define the beta-thalassaemia mutations, prediction of a beta-thalassaemia intermedia phenotype from the genotype sometimes remains problematic and this has important implications in genetic counselling and prenatal diagnosis. We report a 11-year-old Indian male child with a thalassaemia intermedia phenotype. beta-Globin gene analysis of the family showed that he was a compound heterozygote with the -88 (C-->T) beta+-mutation and the IVS1 nt 130 (G-->C) beta0-mutation. Both these mutations are rare among Indians. The propositus was also found to be heterozygous for the XmnI polymorphism and had a normal alpha-genotype. In this family interplay of two alleviating mutations (a milder promoter mutation along with a gene for raised HbF) might have synergistically compensated for lack of globin chains in the patient. Hence, the nature of the beta-genotype as well as the knowledge of the presence or absence of alleviating factors will help the clinician to decide whether early commencement of a regular transfusion regime is necessary.
authors.affiliation: Institute of Immunohaematology (I.C.M.R.), K.E.M. Hospital Campus Parel, Mumbai, India.
authors.forename: A
authors.initials: A
authors.lastname: Nadkarni
authors.forename: T
authors.initials: T
authors.lastname: Sakaguchi
authors.forename: A
authors.initials: A
authors.lastname: Gorakshakar
authors.forename: S
authors.initials: S
authors.lastname: Phanasgaonkar
authors.forename: R
authors.initials: R
authors.lastname: Kiyama
authors.forename: R
authors.initials: R
authors.lastname: Colah
authors.forename: D
authors.initials: D
authors.lastname: Mohanty
mesh_terms: D002648:Child; D006801:Humans; D007194:India; D008297:Male; D009154:Mutation; D010641:Phenotype; D017086:beta-Thalassemia / Q000097:blood / Q000175:diagnosis* / Q000235:genetics