Hemoglobin disorders final
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Transcript of Hemoglobin disorders final
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Hemoglobin DiseasesGROUP 10
Reporters:Yang, Sheryl RayZagada, TimothyZamora, MarvinZapanta, Patricia Joyce
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Hemoglobin 101Yang, Sheryl Ray
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Primary function of the Red blood cell is to manufacture hemoglobin, which in turn, transports oxygen to the tissues and carbon dioxide from tissues to the lungs.
Hemoglobin molecule is composed of four subunits, each containing heme and globin
Hemoglobin Synthesis
1 HEME = 1 MOL OF O21 HEMOGLOBIN = 4 MOL OF O2
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Protein component called globin Four molecules of the nitrogenous substance
Protoporhpyrin IX Four Iron atoms at Ferrous (Fe+2) state that
combine with Protoporphyrin IX to form four heme molecules
One 2,3 Diphosphoglycerate (2,3 DPG) molecule as a sometime resident in the center of Hb unit
Hemoglobin Synthesis
Components of Hemoglobin
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Heme Synthesis
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Protoporhyrin IX
Fe+2
Ferroprotoporphyrin IX
(HEME)
Heme Synthesis
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Produced on specific ribosomes in the cytoplasm of red blood cells. The globin in each hemoglobin molecule consists of four polypeptide chains which determine the type of hemoglobin formed.
Globin Chains
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Greek Designation
Greek Name
No. of Amino Acids
Chromosome
α Alpha 141 16
β Beta 146 11
δ Delta 146 11
γ Gamma 146 11
ε Epsilon 146 11
ζ Zeta 146 16
Globin Chains in Hemoglobin
• Consist of varied sequences of amino acids
– polypeptide chains
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Hemoglobin
Molecular structure
Stage of life
ProportionNewborns
ProportionAdults
Portland 2 Zeta +2 Gamma
Embryonic 0 0
Gower I 2 Zeta +2 Epsilon
Embryonic 0 0
Gower II 2 Alpha +2 Epsilon
Embryonic 0 0
Hb A1 2 Alpha +2 Beta
Newborn & Adult
20 97
Hb A2 2 Alpha +2 Delta
Newborn & Adult
<0.5 2.5
Hb F (Fetal)
2 Alpha +2 Gamma
Newborn & Adult
80 <1
Normal Human Hemoglobin
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Hemoglobin MoleculeHb A1
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T and R states of Hemoglobin • Hemoglobin exists in two major
conformational states: Relaxed (R ) and Tense (T)
• R state has a higher affinity for O2. • In the absence of O2, T state is more
stable; when O2 binds, R state is more stable, so hemoglobin undergoes a conformational change to the R state.
• The structural change involves readjustment of interactions between subunits.
Tensed and Relaxed State
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Tensed and Relaxed State
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O2- Dissociation Curve
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Iron in the ferrous state is required to convert protoporphyrin Ix to heme.
Circumstances that cause reduction in the iron available for Hb synthesis or failure to incorporate iron into heme will cause anemia to develop.
Iron Metabolism for Heme Synthesis
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Most common cause of anemia Due to
INCREASED PHYSIOLOGIC DEMANDS Rapid growth; infants, children Pregnancy, lactation
Iron Deficiency Anemia
* INADEQUATE INTAKE* Iron deficient diet* Inadequate absorption
* CHRONIC BLOOD LOSS* Menstrual flow* Gastrointestinal bleeding* Regular blood donation* Chronic hemolysis
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Effect of IDA
Protoporhyrin IX
Fe+2
Ferroprotoporphyrin IX
(HEME)
Hemoglobin
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Hemoglobinopathy Conditions caused by qualitative structural
abnormalities of the globin polypeptide chains that result from alteration of the DNA genetic code for those chains
Hemoglobinopathies and Thalassemias
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Thalassemias Conditions caused by quantitative
abnormality in globin chain (i.e., reduced or no production).
Hemoglobinopathies and Thalassemias
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Sickle Cell AnemiaZamora, Marvin
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Hgb S – most common abnormal hemoglobin
- Normal glutamic acid at 6th position in the β chain is replaced by Valine
Results in:- Altered solubility- Altered ability to withstand oxidation- Instability- Increased propensity for
methemoglobin production- Increased or decreased oxygen
affinity
Sickle cell disease
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Sickle cell anemia
- Sickle cell disease (SCD)- Drepanocytosis- Hb SS- SS disease- Hemoglobin S- Homozygous
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Sickle cell trait
Is the heterozygous state of SCD One sickle gene and one normal hemoglobin
gene (Hb AS) Usually have no symptoms
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Overview
Sickle cell disease is a general term for a group of genetic disorders caused by sickle hemoglobin (Hgb S or Hb S)
Erythrocytes becomes elongated and sickle shaped Removed from the circulation and destroyed at
increasing rates, leading to anemia.
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Overview An autosomal recessive inherited defect The disease is chronic and lifelong Lifespan average of 40 years.
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Pathophysiology
caused by a point mutation in the β-globin chain of hemoglobin
glutamic acid valine at the 6th
position
*found on the short arm of chromosome 11.
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Pathophysiology Sickling occurs when oxygen decreases at the
tissue level – dissociation of oxygen from RBC Polymerization of Hgb molecules to crystals
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Sickle cell crises
Vasoocclusive crises- Increase in blood viscosity- restricts blood flow to an organ
Hemolytic crises – acute accelerated drops in Hgb levels and RBCs break down at a faster rate.- common in patients with G6PD deficiency
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Sickle cell crisesInfectious crises
- Abnormal splenic function- Depressed immune function- Streptococcus Pneumoniae is the major infectious agent among children
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Sickle cell crises
Aplastic crises- caused by infection and fever- Parvovirus B19- Folate deficiency
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Sickle cell crises
Bone, joint and other crises:- Hand-foot syndrome or Dactylitis- Priapism- Gallstones
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Sickle cell anemia
Laboratory findings-severe anemia (Hgb 5-9 g/dl)-normocytic, normochromic RBC-aniso and poikilocytosis is present-with leukocytosis and thrombocytosis
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Diagnosis Blood film appearance Screening tests for
sickling Hemoglobin
electrophoresis
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Hemoglobin electrophoresis A (%)
F(%)
S (%)
C (%)
D (%)
E (%)
Degree of clinical abnormality
Hemoglobinopathy
Hb CC 1-7
>90 Mild
Hb AC 50-60
<2
40-50
None
Hb SC 1-7
50 50 Mod - Severe
Hb SS 1-10
80-90
Severe
Hb AS 55-70
<2
30-45
None/Mild
Hb DD <2
95 None
Hb AD 50-65
<2
35-50
None
Hb EE 1-5
95 Mild
Hb AE 60-80
20-40
None
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Treatment
*Blood transfusion of PRBC*Administration of antisickling agents
-Cyanate-Urea-Nitrogen mustard-zinc procaine hydrochloride, Citiedil, and
piracetam
*Bone marrow transplantation
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ThalassemiaZapanta, Patricia Joyce
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THALASSEMIA SYNDROMES Each individual has 4 genes of hemoglobin
( HBA1, HBA2, HBB1,HBB2) (aa/aa)(bb/bb) Thalassemia is characterized by partial or
total absence of one or more chains of hemoglobin (either α chain or β chain). Resulting to abnormal form of hemoglobin. Which leads to destruction of RBC leads to anemia
It is a genetic disorder TYPES OF THALASSEMIA
1. α - thalassemia 2.β - thalassemia
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THALASSEMIA
DEMOGRAPHIC Southeast Asia and Meditteranian regionCLINICAL PRESENTATION MINOR – mild anemia confused with iron
deffeciancy INTERMEDIATE-moderate anemia MAJOR- severe anemia – hydrops fetalis
intrauterine death
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Alpha thalassemia
Deletion of alpha-globin
gene resuts to
Children /Adult
Excess beta globin – usually unstable and
precipitate in cell
Forms HEINZ BODY
Fetal / new born
Iincrease HYPOCHROMIC
and MICROCYTIC RBC
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ALPHA THALASSEMIA
Involves the genes HBA1 and HBA2 Located at chromosome 16 Severity of disease depends on the number
of genes defective or missing
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Alpha (+) thalassemia:-deletion of I or more alpha globin gene If 1 gene = silent carrier If 2 genes = alpha trait (thalassemia minor) If 3 genes = H hemoglobin (thalassemia
intermedia)Alpha (0) thalassemia If 4 genes = Bart hemoglobin (thalassemia
major)
ALPHA THALASSEMIA
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3 normal gene (-a/aa) Normal patient
Silent Carrier/ Alpha thalassemia minima/ alpha
thalassemia – 2 trait
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2 normal gene(aa/--) – cis form(-a/-a) – trans form
Clinically normal Minimal anemia Decrease MCV and MCH
Alpha thalassemia trait/ alpha thalassemia minor/ alpha thalassemia – 1 trait
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Only 1 normal alpha-globin gene (-a/--) Increase ratio beta globin : alpha globin Sensitive to oxidative stress RBC prone to hemolyze
Hemoglobin H / HbH disease
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All 4 alpha globin gene is deleted (--/--) Most severe case Hydrops fetalis
Bart’s Hemoglobin/ alpha (0) thalassemia
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BETA THALASSEMIA Β thalassemia will not manifest at birth since
predominant is Hgb F. production of B chain will occur only at 3 – 6 months after birth
Involves the gene HBB1 and HBB2 Located at chromosome 11 Severe transfusion dependent anemia
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BETA THALASSEMIATYPE OF BETA THALASEMIA Homozygous beta thalassemia ( thalassemia
major, cooley’s anemia, Meditteranean anemia) - severe life long-all beta gene mutated-severe anemia
Heterozygous beta thalassemia (thalassemia minor)
-one normal beta chain and 1 abnormal beta chain
-mild anemia
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THALASSEMIA LAB DIAGNOSTICS
Peripheral Blood Smear -Target cells, Heinze bodies, basophilic
strippling, nucleated RBC Reticulocyte – increased Decreased osmotic fragility Iron storage disease
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As blood glucose enters the erythrocytes it glycosylates the ε-amino group of lysine residues and the amino terminals of hemoglobin.
RBC life span – 120 days
HbA1c and Diabetes
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HbA1c and Diabetes
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HbA1c Normal/abnormal Blood glucose level via meter
4.0 - 6.0% Normal for those without diabetes
3 – 8mmol/L
6.1 – 7.0% Target range for those with diabetes
4 – 8mmol/L
7.1 – 8.0% High 8 – 11mmol/L
8.1 – 9.0% Too high 11 – 14mmol/L
Greater than 9.1% Very high 15mmol/L and above
HbA1c and Diabetes
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HbA1c and Diabetes
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Laboratory Experiment: Hgb Determination
Zagada, Timothy
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Cyanmethemoglobin method
A method used for hemoglobin determination
The reagent hemolyzes the erythrocytes which releases the hemoglobin into the solution.
REACTIVE INGREDIENTS: -potassium cyanide and potassium ferricyanide.
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Principle in Cyanmethemoglobin method
When blood is mixed with a solution containing potassium ferricyanide and potassium cyanide, the potassium ferricyanide oxidizes iron to form methemoglobin.
The potassium cyanide then combines with methemoglobin to form cyanmethemoglobin
Hgb(Fe++)K3Fe(CN)6Methemoglobin(Fe+++)
KCNCyanmethemoglobin
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Procedure
Hgb Reagent (5ml)
Mix well. Stand for 3 min
Read at spectrophotometer
+20ul blood sample (EDTA whole blood)
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PURPOSE OF EDTA
EDTA (ethylenediaminetetraacetic acid) is the most commonly used anticoagulant in evacuated tubes.
EDTA reduces platelet activation by protecting the platelets during contact with the glass tube that may initiate platelet activation.
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RESULTS
Group 6 Group 7 Group 8 Group 9 Group 10
Hgb g/dL
17.9 15.57 19.5 17.74 22
2.5
7.5
12.5
17.5
22.5
Hgb concentration per sample
Hg
b c
on
cen
trati
on
Normal:Male: 13-18 g/dLFemale: 12-16 g/dL
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SOURCES OF ERRORS
Technical Error- Pipeting- Use of dirty, scratched or unmatched
cuvettes- Use of deteriorated reagents- Incorrectly calibrated spectrophotometer
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SOURCES OF ERRORS
Physiologic Error- Turbidity in the mixture causes falsely
elevated values
Turbidity maybe caused by: Lipemia Extremely high leukocyte counts Easily precipitated Globulins
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Factors that affect Hemoglobin
Increased Hemoglobin kidney releases too much erythropoietin People living in high altitudes Anabolic steroid Smoking DehydrationPolycythemia vera
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Factors that affect Hemoglobin
Decreased Hemoglobin-Vitamin-deficiency Anemiadeficiency of vitamin B12 or folate-BleedingBlood volume is replaced more quickly than red blood cells, leading to a lower concentration of hemoglobin-Kidney Diseaseresults in lower levels of erythropoietin-Pregnancy-Blood Disorders