title: Identification and molecular characterization of a novel 163 kb deletion: The Italian (ϵγδβ)(0)-thalassemia.
abstract: OBJECTIVE
  To verify the presence of β-thalassemia in subjects showing hematologic phenotype of α-thalassemia, conduct normal molecular sequence analysis of the α-globin genes, and detect the absence of the most frequent α-thalassemia deletions.
  
  
  METHODS
  A patient from Apulia (Southern Italy) was referred to our institution for the occasional founding of hypochromic polyglobulia and microcytic red blood cells associated with normal levels of Hb A2 and Hb F and normal iron parameters.
  
  
  METHODS
  The patient has been investigated using Sanger sequencing, multiplex ligation-dependent probe amplification (MLPA), quantitative real-time PCR, restriction analysis, and gap-PCR. A novel deletion, the Italian (ϵγδβ)(0)-thalassemia, has been identified. The 5' breakpoint was within a LINE element of 80 kb 3' of the ε-globin gene, and the 3' breakpoint was within a 160-bp palindrome of about 30 kb 5' of the β-globin gene. The breakpoint region was characterized by the presence of a microhomology (5'-TCT-3') and of an insertion of 43 bp owing to the duplication of the 160-bp palindrome. Comparison of the Hb and Hb A2 values of (ϵγδβ)(0)-thalassemia from the literature with those of (molecularly known) thalassemia carriers indicated a higher level of Hb A2 with respect to α-thalassemia and a lower level of Hb with respect to β(0)-thalassemia carriers.
  
  
  CONCLUSIONS
  In this study, we report the first (ϵγδβ)(0)-thalassemia case identified in Italy. To avoid misdiagnosis of β-thalassemia, we suggest verifying the presence of large deletions of the β-globin gene cluster in subjects showing a higher border line level of Hb A2 and a lower level of Hb.
authors.affiliation: a Istituto di Genetica e Biofisica "Adriano Buzzati-Traverso" - CNR , Napoli , Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Cardiero
authors.affiliation: a Istituto di Genetica e Biofisica "Adriano Buzzati-Traverso" - CNR , Napoli , Italy.
authors.forename: Romeo
authors.initials: R
authors.lastname: Prezioso
authors.affiliation: b Azienda Ospedaliero-Universitaria , Ospedali Riuniti, Foggia , Italy.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Dembech
authors.affiliation: c Dipartimento di Biochimica, Biofisica e Patologia Generale , Seconda Università degli Studi di Napoli , Napoli , Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Del Vecchio Blanco
authors.affiliation: b Azienda Ospedaliero-Universitaria , Ospedali Riuniti, Foggia , Italy.
authors.forename: Clelia
authors.initials: C
authors.lastname: Scarano
authors.affiliation: a Istituto di Genetica e Biofisica "Adriano Buzzati-Traverso" - CNR , Napoli , Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Lacerra
mesh_terms: D000328:Adult; D001483:Base Sequence; D006801:Humans; D007558:Italy; D008297:Male; D017384:Sequence Deletion; D013789:Thalassemia / Q000097:blood / Q000235:genetics*; D055542:alpha-Globins / Q000235:genetics* / Q000378:metabolism
chemical_list: D055542:alpha-Globins
keywords: (ϵγδβ)0-Thalassemia; Beta-thalassemia misdiagnosis; Italian patient; MLPA; novel deletion