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Transfusion-acquired Hemoglobinopathies: A Report of Two Cases.

Somasundaram V, Purohit A, Manivannan P, Saxena R - J Lab Physicians (2015 Jul-Dec)

Bottom Line: Transfusion-acquired hemoglobinopathy occurs when a carrier of hemoglobinopathy with no significant abnormalities donates blood, and the blood is transfused to a recipient.This process can lead to spurious results in the recipient without any clinical abnormality or infrequently can result in disastrous situations.The incidental finding of such posttransfusion related abnormal peaks in hemoglobin high-performance liquid chromatography (Hb HPLC) may cause diagnostic dilemmas and result in unnecessary laboratory testing.

View Article: PubMed Central - PubMed

Affiliation: Department of Hematology, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT
Transfusion-acquired hemoglobinopathy occurs when a carrier of hemoglobinopathy with no significant abnormalities donates blood, and the blood is transfused to a recipient. This process can lead to spurious results in the recipient without any clinical abnormality or infrequently can result in disastrous situations. The incidental finding of such posttransfusion related abnormal peaks in hemoglobin high-performance liquid chromatography (Hb HPLC) may cause diagnostic dilemmas and result in unnecessary laboratory testing. Here, we report two such cases of transfusion-acquired hemoglobinopathies, which were subsequently resolved by the abnormally low percentage of the Hb variants, transient nature of the peaks, and parental Hb HPLC.

No MeSH data available.


Related in: MedlinePlus

(a) Hemoglobin high-performance liquid chromatography of patient showing a peak in D-window of 8.9% with a retention time of 4.07 min. Chromatogram of father (b) and mother (c)
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Figure 1: (a) Hemoglobin high-performance liquid chromatography of patient showing a peak in D-window of 8.9% with a retention time of 4.07 min. Chromatogram of father (b) and mother (c)

Mentions: First case, an 8-year-old male child was brought with history of transfusion-dependent anemia since 6 months of age with an hemoglobin (Hb) of 8.4 g/dL and peripheral smear showing microcytic hypochromic red cell picture [Table 1]. Considering the possibility of thalassemia major and unavailability of prior Hb HPLC report, Hb HPLC (BioRad Variant II, β- thalassemia Short Program) was carried out in our department, which showed a HbF level of 1.9%, with HbA0 73.0%, HbA2 2.4% and a peak in D-window of 8.9% with a retention time of 4.07 min [Figure 1a]. Percentage of HbD in heterozygotes for HbD approximates 40%, hence, a possibility of transfusion-acquired HbD was considered. Hb HPLC of both parents revealed heterozygous state for β-thalassemia [Figure 1b and c]. However, there was no abnormal peak at D-window in both the parents. A repeat Hb HPLC on patient's blood was carried just prior to the next transfusion, which revealed a decline in the percentage of the peak in D-window to 1.6%. The patient was on regular transfusion and had received transfusion 2 weeks prior to the first Hb HPLC, which could have been the reason for the transfusion-associated peak.


Transfusion-acquired Hemoglobinopathies: A Report of Two Cases.

Somasundaram V, Purohit A, Manivannan P, Saxena R - J Lab Physicians (2015 Jul-Dec)

(a) Hemoglobin high-performance liquid chromatography of patient showing a peak in D-window of 8.9% with a retention time of 4.07 min. Chromatogram of father (b) and mother (c)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4559627&req=5

Figure 1: (a) Hemoglobin high-performance liquid chromatography of patient showing a peak in D-window of 8.9% with a retention time of 4.07 min. Chromatogram of father (b) and mother (c)
Mentions: First case, an 8-year-old male child was brought with history of transfusion-dependent anemia since 6 months of age with an hemoglobin (Hb) of 8.4 g/dL and peripheral smear showing microcytic hypochromic red cell picture [Table 1]. Considering the possibility of thalassemia major and unavailability of prior Hb HPLC report, Hb HPLC (BioRad Variant II, β- thalassemia Short Program) was carried out in our department, which showed a HbF level of 1.9%, with HbA0 73.0%, HbA2 2.4% and a peak in D-window of 8.9% with a retention time of 4.07 min [Figure 1a]. Percentage of HbD in heterozygotes for HbD approximates 40%, hence, a possibility of transfusion-acquired HbD was considered. Hb HPLC of both parents revealed heterozygous state for β-thalassemia [Figure 1b and c]. However, there was no abnormal peak at D-window in both the parents. A repeat Hb HPLC on patient's blood was carried just prior to the next transfusion, which revealed a decline in the percentage of the peak in D-window to 1.6%. The patient was on regular transfusion and had received transfusion 2 weeks prior to the first Hb HPLC, which could have been the reason for the transfusion-associated peak.

Bottom Line: Transfusion-acquired hemoglobinopathy occurs when a carrier of hemoglobinopathy with no significant abnormalities donates blood, and the blood is transfused to a recipient.This process can lead to spurious results in the recipient without any clinical abnormality or infrequently can result in disastrous situations.The incidental finding of such posttransfusion related abnormal peaks in hemoglobin high-performance liquid chromatography (Hb HPLC) may cause diagnostic dilemmas and result in unnecessary laboratory testing.

View Article: PubMed Central - PubMed

Affiliation: Department of Hematology, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT
Transfusion-acquired hemoglobinopathy occurs when a carrier of hemoglobinopathy with no significant abnormalities donates blood, and the blood is transfused to a recipient. This process can lead to spurious results in the recipient without any clinical abnormality or infrequently can result in disastrous situations. The incidental finding of such posttransfusion related abnormal peaks in hemoglobin high-performance liquid chromatography (Hb HPLC) may cause diagnostic dilemmas and result in unnecessary laboratory testing. Here, we report two such cases of transfusion-acquired hemoglobinopathies, which were subsequently resolved by the abnormally low percentage of the Hb variants, transient nature of the peaks, and parental Hb HPLC.

No MeSH data available.


Related in: MedlinePlus