Inter Trimester Hemoglobin Levels in Pregnant Women

Hemoglobin functions to transport all oxygen from the lungs to the tissue cells. Hemoglobin contains iron and is still present in red blood cells. In pregnant women hemoglobin levels are often abnormal. According to PMK RI No. 97 of 2014 concerning health services, it stipulates that pregnant women are checked for hemoglobin at least once in the first trimester and once in the third trimester. This is done to determine the condition of pregnant women during pregnancy. Low hemoglobin levels cause anemia. Anemia in pregnant women can affect the process of fetal growth and development in the womb. The purpose of this study was to determine the hemoglobin level between trimesters in pregnant women at the Jatilawang Health Center, Banyumas Regency in 2020. The research criteria was a descriptive study using a retrospective time series design using secondary data. The results of inter-trimester hemoglobin levels in pregnant women at the Jatilawang Health Center, Banyumas Regency in 2020 are in the first trimester 40% normal hemoglobin levels and 60% abnormal hemoglobin levels, in the second trimester hemoglobin levels are 72% normal and 28% hemoglobin levels are not normal, in the second trimester the hemoglobin levels are normal and 28% are abnormal. III 96% normal hemoglobin level and 4% abnormal hemoglobin level. Inter-trimester hemoglobin levels in pregnant women at the Jatilawang Health Center, Banyumas Regency in 2020 tend to be higher based on trimesters I, II and III.

The Role of miRNAs as Therapeutic Tools in Sickle Cell Disease

Background and Objectives: Sickle cell disorder (SCD) is a paradigmatic example of a complex monogenic disorder. SCD is characterized by the production of abnormal hemoglobin, primarily in the deoxygenated state, which makes erythrocytes susceptible to intracellular hemoglobin polymerization. Functional studies have affirmed that the dysregulation of miRNAs enhances clinical severity or has an ameliorating effect in SCD. miRNAs can be effectively regulated to reduce the pace of cell cycle progression, to reduce iron levels, to influence hemolysis and oxidative stress, and most importantly, to increase γ-globin gene expression and enhance the effectiveness of hydroxyurea. Results: This review highlights the roles played by some key miRNAs in hemoglobinopathies, especially in hematopoiesis, erythroid differentiation, and severity of anemia, which make miRNAs attractive molecular tools for innovative therapeutic approaches. Conclusion: In this era of targeted medicine, miRNAs mimics and antagomirs may be promising inducers of HbF synthesis which could ameliorate the clinical severity of SCD.

Comparison of Smoking Habits and Coffee Consumption In Adolescents Against Hemoglobin Levels In Mojoroto Kediri City

Cigarettes are processed tobacco using or without addictive substances. The increasing of hemoglobin in smokers due to the content of carbon monoxide causes hemolysis of erythrocytes that is stronger than oxygen, so that hemoglobin increases. In addition to smoking, the society's habit is about coffee consumption. Coffee is a beverage with high polyphenols. The decreasing of hemoglobin occurs when drinking too much coffee. It will reduce the absorption of iron and erythrocytes ability to deliver oxygen from the lungs to all tissues in the body, therefore the hemoglobin will decrease. One of the laboratory tests that is used to see hemoglobin levels in smokers and coffee consumers is the POCT method of hemoglobin examination. The purpose of this study was to analyze the comparison of the effect between smoking and coffee consumption on hemoglobin levels in adolescents on the streets of Mejenan Gang 3 Mojoroto Kediri. The method that is used in this research is comparative study and the sampling technique that is used purposive sampling with a sample size of 40 respondents. The results show that 10 adolescents (50%) had abnormal hemoglobin levels and 10 adolescents (50%) had normal hemoglobin levels. 5 teenagers (25%) had abnormal hemoglobin levels and 15 (75%) normal hemoglobin levels. Based on statistical tests, the results obtain p-value 0.423 and> 0.05. So it can be concluded that there is a moderate effect between cigarettes and coffee on hemoglobin levels in adolescents on Mejenan Street Gang 3 Mojoroto Kediri.

Risk Factors Associated with Diabetic Retinopathy and Thalassemia Prevalence Survey in Diabetes Mellitus Patients at Six Primary Care Units of Naresuan University Hospital: A Cross-sectional Study

Objective: To evaluate the risk factors and prevalence of diabetic retinopathy (DR) in both medical and socioeconomic aspects and find prevalence of thalassemia which associated hemoglobin A1c (HbA1c) measurement in diabetes mellitus (DM) patients at six primary care units (PCU) of Naresuan University Hospital (NUH). Materials and Methods: A cross-sectional survey of DM patients participated in annual proactive DR screening program at six PCU of NUH between December 2016 and March 2017 was conducted. Medical data were retrieved from medical records at PCU. Patients were also interviewed to gather socioeconomic information. Fundus examination was done by indirect ophthalmoscope. Three milliliters of blood was collected from each patient on the same day for Hb analysis. Results: Four hundred and eighty-eight DM patients participated in the present study. Mean age, duration of DM, fasting blood sugar (FBS) level, and HbA1c level were 61.2±9.8 years, 8 years (4 to 12), 124 mg/dL (108 to 151.5), and 7.1% (6.5 to 8.1), respectively. Prevalence of overall DR was 2.9% (14 patients) and proliferative DR was 0.2% (1 patient). Risk factors of DR were HbA1c at 7% or more [adjusted OR 4.7 (95% CI 1.4 to 13.5) and p=0.011] and emotional stress [adjusted OR 3.3 (95% CI 1.1 to 9.8) and p=0.033). Thalassemia screening found 116 patients had abnormal hemoglobin. Ninety-three patients were HbE trait, eight were HbE, ten were alpha-thalassemia trait, two were beta-thalassemia trait, one was HbH, one was alpha- and beta-thalassemia trait (α/β), and one was alpha-thalassemia trait and HbE trait (α/E), and all of them were thalassemia minor or intermedia. Only four patients from HbE trait group had DR. The mean HbA1c in all groups of patients with either normal or abnormal hemoglobin were not statistically significant different. Conclusion: The present study showed that HbA1c and emotional stress might have played an important role in association with DR development. Thalassemia minor and intermedia seemed not to associate with HbA1c measurement. Keywords: Diabetic retinopathy; Thalassemia; Primary care unit; Naresuan university; Risk factors

Unexpected Detection of Abnormal Hemoglobin Variants During Routine HbA1c Analysis by HPLC Technique: Challenges and Opportunities in HbA1c Testing

Background: Glycated Hemoglobin A1c (HbA1c) assay is most widely used in diabetic patients for assessing long-term control of glycemia. The presence of hemoglobin variants may be an incidental finding and can interfere with HbA1c measurements. The aim of the present study is to investigate the prevalence and impact of interference of different abnormal hemoglobin variants on HbA1c measurements during routine HbA1c testing. Methods: A total of 12,092 HbA1c samples were collected from January to August 2018. HbA1c quantification was carried out on a Variant II Bio-Rad’s HPLC analyzer. Abnormal chromatograms were further analyzed using the extended-run high-pressure liquid chromatography (HPLC) analysis in the A2/F mode. Results: The samples were examined for presence of abnormal variants. Samples producing abnormal chromatograms were further analyzed in A2/F mode to characterize hemoglobin variants. Abnormal variants were identified in 126 (1%) samples, and 74 (0.59%) sickle cell traits (SCT) were the most common variant in our findings. Moreover, 30 (0.24%) cases were eluted in the variant window in A1c mode, which on further analysis were found to be Hb E & Hb D traits. Furthermore, 3 (0.02%) cases were eluted at a RT <1 min as (unknown) and identified as Hb H. Also,19 (0.15%) samples were eluted in the P3 window at different retention times. Conclusion: Observing each chromatograph after the analysis can help us in identifying silent hemoglobin variants in routine HbA1c testing. Knowledge and awareness of common hemoglobin variants affecting measurement of HbA1c is imperative to avoid reporting of falsely low HbA1c values in diabetic population.

Misleading HbA1c Measurement in Diabetic Patients with Hemoglobin Variants

Background and Objectives: Hemoglobin A1c (HbA1c) is widely used for the monitoring and management of diabetes mellitus. The aim of this study is to investigate the influence of hemoglobin (Hb) variants on the measurement of HbA1c. Materials and Methods: HbA1c levels of 845 blood samples obtained from diabetic patients with various hemoglobin types were measured using a turbidimetric inhibition immunoassay and capillary electrophoresis. Results: Of 845 patients with diabetes, 65.7% (555/845) have the normal hemoglobin type (A2A) and 34.3% (290/845) have various abnormal hemoglobin types, including heterozygous HbE 30.2% (255/845), homozygous HbE 1.9 % (16/845), Hb Constant Spring (CS) trait 1.4% (12/845), CSEA Bart’s 0.2% (2/845), and beta-thalassemia trait 0.6% (5/845). In most of the patients with diabetes, HbA1c levels determined by two different methods, inhibition immunoassay and capillary electrophoresis, gave strong positive correlation (R = 0.901, P < 0.001), except for those with homozygous HbE (N = 16) and CSEA Bart’s (N = 2). In all 18 patients with homozygous HbE and CSEA Bart’s, the HbA1c was undetectable by capillary electrophoresis, meaning that their estimated average glucose was undeterminable, although their HbA1c levels could be measured using an inhibition immunoassay. The discrepancy of HbA1c results obtained from two different methods is noted in patients without HbA. Conclusions: We have demonstrated the erroneous nature of HbA1c measurement in patients with hemoglobin variants, especially in those without HbA expression. Therefore, in the population with a high prevalence of hemoglobinopathies, hemoglobin typing should be considered as basic information prior to HbA1c measurement.

Chronic osteo-articular changes in patients with sickle cell disease

Background Sickle cell disease (SCD) is an autosomal recessive genetic disease in which a mutation occurs in the β-globin chain gene, resulting in abnormal hemoglobin levels. In an environment with reduced oxygen concentration, red blood cells change their conformation, resulting in chronic hemolysis and consequent anemia and vaso-occlusive crises with injuries to several organs, with a significant impairment of the osteoarticular system. This study aimed to verify the chronic osteoarticular alterations and their association with clinical and laboratory characteristics of patients with SCD with a more severe phenotype (SS and Sβ0), on a steady-state fasis. Methods Fifty-five patients were referred to a medical consultation with a specialized assessment of the locomotor system, followed by laboratory tests and radiographic examinations. Results In total, 74.5% patients had hemoglobinopathy SS; 67.3% were female; and 78.2% were non-whites. The mean patient age was 30.5 years. Most patients (61.8%) reported up to three crises per year, with a predominance of high-intensity pain (65.5%). Radiographic alterations were present in 80% patients. A total of 140 lesions were identified, most which were located in the spine, femur, and shoulders. Most lesions were osteonecrosis and osteoarthritis and were statistically associated with the non-use of hydroxyurea. Conclusions There was a high prevalence of chronic osteoarticular alterations, which was statistically associated only with the non-regular use of hydroxyurea.

Usefulness of NGS for Diagnosis of Dominant Beta-Thalassemia and Unstable Hemoglobinopathies in Five Clinical Cases

Unstable hemoglobinopathies (UHs) are rare anemia disorders (RADs) characterized by abnormal hemoglobin (Hb) variants with decreased stability. UHs are therefore easily precipitating, causing hemolysis and, in some cases, leading to dominant beta-thalassemia (dBTHAL). The clinical picture of UHs is highly heterogeneous, inheritance pattern is dominant, instead of recessive as in more prevalent major Hb syndromes, and may occur de novo. Most cases of UHs are not detected by conventional testing, therefore diagnosis requires a high index of suspicion of the treating physician. Here, we highlight the importance of next generation sequencing (NGS) methodologies for the diagnosis of patients with dBTHAL and other less severe UH variants. We present five unrelated clinical cases referred with chronic hemolytic anemia, three of them with severe blood transfusion dependent anemia. Targeted NGS analysis was performed in three cases while whole exome sequencing (WES) analysis was performed in two cases. Five different UH variants were identified correlating with patients’ clinical manifestations. Four variants were related to the beta-globin gene (Hb Bristol—Alesha, Hb Debrousse, Hb Zunyi, and the novel Hb Mokum) meanwhile one case was caused by a mutation in the alpha-globin gene leading to Hb Evans. Inclusion of alpha and beta-globin genes in routine NGS approaches for RADs has to be considered to improve diagnosis’ efficiency of RAD due to UHs. Reducing misdiagnoses and underdiagnoses of UH variants, especially of the severe forms leading to dBTHAL would also facilitate the early start of intensive or curative treatments for these patients.

Artemisinin derivative-containing therapies and abnormal hemoglobin: Do we need to adapt the treatment?

Background: Artemisinin-based treatment in malaria patients with abnormal hemoglobin may be ineffective because of their genetic particularity, which could lead to resistance. The main purpose of this study was to assess the effect of artemisinin derivatives on in vivo parasite clearance according to erythrocyte variants. In vivo response was investigated through retrospective data obtained over a 42-day artemether-lumefantrine/artesunate amodiaquine efficacy protocol conducted from 2012 to 2016. Results: A total of 770 patients in Côte d’Ivoire attending the hospitals of Anonkoua-koute (Abidjan), Petit Paris (Korhogo), Libreville (Man), Dar es salam (Bouaké), Ayamé and Yamoussoukro with acute uncomplicated falciparum malaria were selected for successful hemoglobin typing. HbAS, HbSS, HbAC, and HbSC genotypes were found. Parasite clearance time was obtained for 414 patients. In the population with abnormal hemoglobin, parasite densities on admission and parasite clearance rates were significantly lower in the HbSC group compared to HbAA (p = 0.02 and p = 0.007, respectively). After PCR correction on day 42, the acute treatment rate was 100% for each group. Parasite half-life and time for initial parasitaemia to decline by 50 and 99% were longer for the HbSC group (p < 0.05). The study also investigated the prevalence of K13-propeller polymorphisms across different hemoglobin genotype groups. A total of 185 and 63 samples were sequenced in the HbAA group and patients with abnormal Hb, respectively. Only two nonsynonymous mutations D559N and V510M were found in the HbAA group. Conclusion: Although this study proved good efficacy of artemether-lumefantrine and artesunate amodiaquine in the treatment of uncomplicated Plasmodium falciparum malaria in patients with abnormal hemoglobin, the increased delay of parasite clearance may represent a threat to health in these patients in relation with sickle cell crisis, which could support selection of parasites resistant to artemisinin.

Genetic screening of newborns in Baku for hereditary hemoglobinopathies

Наследственные гемоглобинопатии, входят в группу заболеваний крови, называемых гемолитическими анемиями. В общем случае гемоглобинопатии развиваются из-за синтеза аномального гемоглобина. Гемолитические анемии встречаются примерно у 12% населения Земного шара. Данная статья посвящена результатам генетического скрининга новорожденных г. Баку с целью исследования частоты гемоглобинопатий. Обследованы 267 новорожденных, 143 мальчика и 124 девочки. Исследования проводились в 2018-2019 гг. методом изоэлектрофокусирования. В статье также изложены результаты молекулярной диагностики β-талассемии у новорожденных методом высокотемпературной аллель-специфической амплификации. По данным проведенного исследования наследственных гемоглобинопатий в сыворотке крови новорожденных гор. Баку установлено наличие структурно-аномальных гемоглобинов S и D и патологических аллелей генов α- и β-талассемий. Идентифицированы типы мутаций β-талассемий. Полученные результаты генетического скрининга позволят своевременно проводить лечение больных детей до проявления клиники заболевания. Hereditary hemoglobinopathies are part of a group of blood diseases called hemolytic anemias. In general, hemoglobinopathy is the synthesis of abnormal hemoglobin. Hemolytic anemias occur in approximately 12% of the world’s population. This article is devoted to the results of genetic screening among newborns in Baku in order to study the frequency of hemoglobinopathies. The study involved 267 newborns. Among them are 143 boys and 124 girls. The studies were carried out in 2018-2019. To determine hemoglobinopathies among newborns, we used the method of iso-electrofocusing. The article also details the results of molecular diagnostics of the β-thalassemia gene in newborns by high-temperature allele-specific amplification. In Baku, the presence of pathological genes of α- and β-thalassemias and structurally abnormal hemoglobins S and D was established. Types of β-thalassemia mutations have been identified.