title: Molecular pathology of rare bleeding disorders (RBDs) in India: a systematic review.
abstract: BACKGROUND
  Though rare in occurrence, patients with rare bleeding disorders (RBDs) are highly heterogeneous and may manifest with severe bleeding diathesis. Due to the high rate of consanguinity in many caste groups, these autosomal recessive bleeding disorders which are of rare occurrence in populations across the world, may not be as rare in India.
  
  
  OBJECTIVE
  To comprehensively analyze the frequency and nature of mutations in Indian patients with RBDs.
  
  
  METHODS
  Pubmed search was used (www.pubmed.com) to explore the published literature from India on RBDs using the key words "rare bleeding disorders", "mutations", "India", "fibrinogen", "afibrinogenemia", "factor II deficiency", "prothrombin" "factor VII deficiency", "factor V deficiency", "factor X deficiency", "factor XI deficiency", "combined factor V and VIII deficiency", "factor XIII deficiency", "Bernard Soulier syndrome" and "Glanzmanns thrombasthenia" in different combinations. A total of 60 relevant articles could be retrieved. The distribution of mutations from India was compared with that of the world literature by referring to the Human Gene Mutation Database (HGMD) (www.hgmd.org).
  
  
  RESULTS
  Taken together, 181 mutations in 270 patients with different RBDs have been reported from India. Though the types of mutations reported from India and their percentage distribution with respect to the world data are largely similar, yet much higher percentage of small deletions, duplication mutations, insertions, indels were observed in this analysis. Besides the identification of novel mutations and polymorphisms, several common mutations have also been reported, which will allow to develop a strategy for mutation screening in Indian patients with RBDs.
  
  
  CONCLUSIONS
  There is a need for a consortium of Institutions working on the molecular pathology of RBDs in India. This will facilitate a quicker and cheaper diagnosis of RBDs besides its utility in first trimester prenatal diagnosis of the affected families.
authors.affiliation: National Institute of Immunohaematology (I.C.M.R.), MS Building, KEM Hospital campus, Parel, Mumbai, India.
authors.forename: Bipin P
authors.initials: BP
authors.lastname: Kulkarni
authors.affiliation: National Institute of Immunohaematology (I.C.M.R.), MS Building, KEM Hospital campus, Parel, Mumbai, India.
authors.forename: Sona B
authors.initials: SB
authors.lastname: Nair
authors.affiliation: National Institute of Immunohaematology (I.C.M.R.), MS Building, KEM Hospital campus, Parel, Mumbai, India.
authors.forename: Manasi
authors.initials: M
authors.lastname: Vijapurkar
authors.affiliation: National Institute of Immunohaematology (I.C.M.R.), MS Building, KEM Hospital campus, Parel, Mumbai, India.
authors.forename: Leenam
authors.initials: L
authors.lastname: Mota
authors.affiliation: National Institute of Immunohaematology (I.C.M.R.), MS Building, KEM Hospital campus, Parel, Mumbai, India.
authors.forename: Sharda
authors.initials: S
authors.lastname: Shanbhag
authors.affiliation: National Institute of Immunohaematology (I.C.M.R.), MS Building, KEM Hospital campus, Parel, Mumbai, India.
authors.forename: Shehnaz
authors.initials: S
authors.lastname: Ali
authors.affiliation: National Institute of Immunohaematology (I.C.M.R.), MS Building, KEM Hospital campus, Parel, Mumbai, India.
authors.forename: Shrimati D
authors.initials: SD
authors.lastname: Shetty
authors.affiliation: National Institute of Immunohaematology (I.C.M.R.), MS Building, KEM Hospital campus, Parel, Mumbai, India.
authors.forename: Kanjaksha
authors.initials: K
authors.lastname: Ghosh
mesh_terms: D001778:Blood Coagulation Disorders / Q000235:genetics*; D001779:Blood Coagulation Factors / Q000378:metabolism; D030541:Databases, Genetic; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D007194:India; D009154:Mutation / Q000235:genetics; D057089:Pathology, Molecular; D035583:Rare Diseases / Q000235:genetics*
chemical_list: D001779:Blood Coagulation Factors; D005340:Fibrinogen