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PubMed1988

Hemoglobinuria detection in 195 urology patients.

There is a definite need for the development of a specific and sensitive diagnostic test for the detection of hematuria in patients with bladder and kidney cancer. It is well established that hemoglobin in the urine may be indicative of bladder and/or kidney cancer as well as other types of lesions of the urinary tract. We have developed a specific and sensitive immunological assay for the detection of human hemoglobin in urine. This test has several important advantages over the currently used chemical tests. A mouse monoclonal antibody specific for human hemoglobin was produced and used in the development of a double-antibody biotinylated enzyme-linked immunosorbent assay (ELISA) that specifically detected hemoglobin in the urine of 195 urology patients. The results from this assay were compared with data from an evaluation of the same specimen using a polyclonal antibody biotinylated ELISA (PE) as well as a dipstick test in a blind screening study. The monoclonal antibody biotinylated ELISA (ME) possessed a much higher level of sensitivity and specificity over the dipstick test. In addition, we determined that monoclonal as well as polyclonal antibody can detect not only normal hemoglobin but also abnormal hemoglobins in urine. Of the total 195 urology patients in all diagnostic categories, the ME test was positive for detection of hemoglobin in 28 more patients (35% more) than were detected by the dipstick test. Importantly, four of these 28 patients detected by the ME but undetected by the dipstick were patients with bladder or kidney cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2004

Hemoglobin C and hemoglobin O-Arab variants can be diagnosed using the Bio-Rad Variant II high-performance liquid chromatography system without further confirmatory tests.

CONTEXT: Current standards for laboratory accreditation from the College of American Pathologists state that when high-performance liquid chromatography (HPLC) is used as a screening test, all non-A, non-S abnormal hemoglobin (Hb) variants must be confirmed by an alternative method, including alkaline and acid electrophoresis. OBJECTIVE: To determine whether confirmation of Hb C and Hb O-Arab variants by an alternative method is required when using the Bio-Rad Variant II HPLC system. DESIGN: We reviewed 48 478 consecutive hemoglobin identification test results performed on the Bio-Rad Variant II HPLC system during the period November 15, 2000 to January 15, 2003. SETTING: Special Hematology Laboratory, Department of Pathology, Bellevue Hospital Center, New York, NY. MAIN OUTCOME MEASURES: The chromatogram patterns and retention times (RTs) for specimens containing Hb C and Hb O-Arab were analyzed. We compared the results by the HPLC method with those by the confirmatory tests (alkaline and acid electrophoresis) for both variants. RESULTS: We identified 3668 cases of abnormal hemoglobin variants, including 660 cases of Hb C trait (17%), 5 cases of Hb O-Arab trait (0.1%), and 1 case of Hb SO-Arab (0.03%). A unique pattern of separation on the chromatogram for Hb O-Arab was revealed, presenting as 2 distinct peaks in 2 different manufacturer-defined RT windows, namely, D and C. The chromatogram for Hb C did not show the D window in any of the reviewed cases. The RT in the C window (C-RT) revealed a statistically significant difference for Hb C and Hb O-Arab (5.18 +/- 0.01 minutes and 4.91 +/- 0.01 minutes, respectively; P <.001). CONCLUSION: According to our review, the identification of Hb C and Hb O-Arab is accurate using HPLC methodology, as performed by the Bio-Rad Variant II HPLC system. This method can be both confirmatory and diagnostic at the same time.

Blood Protein Electrophoresis↗
PubMed1987

Hb Mississippi [beta 44(CD3)Ser----Arg]: a new variant with anomalous properties.

Hb Mississippi was discovered in a 6-year-old Chinese girl with chronic anemia and thalassemia intermedia. Family studies revealed that she had inherited the Hb Mississippi from her father as well as inheriting a gene for beta+-thalassemia from her mother. Electrophoretic analyses of the hemolysate of the father of the father and the proband on polyacrylamide gels at pH 8.6 showed that the abnormal hemoglobin had three distinct mobilities. A similar pattern was also observed by isoelectricfocusing. In addition, multiple abnormal peaks were observed by high performance liquid chromatographic hemoglobin separations as well as high performance liquid chromatographic globin chain separation. Structural analysis of the abnormal hemoglobin demonstrated a single abnormality; the substitution of serine to cysteine at position 44 (CD3) of the beta-globin chain. Since CD3 is on the surface of the beta-globin chain, it was thought that polymerization of the abnormal hemoglobin by disulfide linkages might have been responsible for the anomalous behavior on electrophoresis and high performance liquid chromatography. Gel filtration chromatography on G-200 Sephadex confirmed this supposition and demonstrated that the abnormal globin chain polymerized with itself as well as with other globin chains.

Amino Acids↗
PubMed1980

Identification and quantitation of sickle cell hemoglobin with an enzyme-linked immunosorbent assay (ELISA).

The experimental details of ELISA for the identification and quantitation of Hb S are presented; the assay is based upon the passive adsorption of Hb S top a solid phase (polystyrene tubes) and the addition of monospecific rabbit antibodies capable of recognizing the (beta 6 Glu leads to Val) substitution in Hb S. After the addition of alkaline phosphatase-conjugated goat antibody to rabbit IgG and substrate, the yellow color produced by hydrolysis of substrate is measured spectrophotometrically. For the identification and quantitation of Hb S in unknown samples, the hemolysate is added to the Hb S-coated tubes before the addition of antibody to Hb S, thus causing an inhibition of the antigen-antibody reaction as evidenced by an absence or reduction of color formation. With this procedure, there is no cross-reactivity with normal hemoglobins, and the immunoassay has a sensitivity in detecting 50 ng quantities of the abnormal hemoglobin in a 5 microgram hemolysate. The assay can be performed on multiple samples in 1 day and offers many advantages over other techniques currently used for the identification and quantitation of Hb S and other abnormal hemoglobins in the clinical laboratory.

Anemia, Sickle Cell↗
PubMed1999

Identification of the Hb Lepore phenotype by HPLC.

BACKGROUND AND OBJECTIVE: Hb Lepore is a structurally abnormal hemoglobin in which the abnormal globin chain is a hybrid or fused globin chain (db). Three different Lepore hemoglobins have been identified, differing from each other in the point at which the db fusion occurs; Hb Lepore Hollandia (d22/b50), Hb Lepore Baltimore (d59/b86) and Hb Lepore Boston (d87/b116). In Spain only Hb Lepore Boston and Hb Lepore Baltimore have been identified. Hb Lepore is easily detected by electrophoretic and chromatographic studies, whereas the type of Hb Lepore is distinguished by chromatography of tryptic peptides of abnormal db chain. In this work, we show an easier chromatography technique for identifying the Hb Lepore phenotype. DESIGN AND METHODS: Thirteen different unrelated families (23 patients) from different parts of Spain were studied. The existence of Hb Lepore was diagnosed by standard methodology and quantified by ionic exchange HPLC. The globin chains were studied by reversed phase HPLC, which showed us the phenotype of Hb Lepore; this phenotype was corroborated by a gold standard test using molecular biology techniques. The statistical analysis was designed to determine the behavior of the quantitative (hematologic) variables using the independent variable (Hb Lepore Baltimore or Hb Lepore Boston) categorized by Student's t-test for independent groups. The distribution of the variable was established using theoretical models and the variance homogeneity hypothesis was tested. The validity of the hematologic data was estimated by creating a receiver operating characteristic (ROC) curve. RESULTS: In the study of globin chains by reversed phase HPLC, in 14 patients (8 families) three peaks were eluted; they corresponded to a, b and db globin chains. In these cases when DNA was studied by PCR followed by digestion with the restriction enzyme Pvu II, the phenotype of Hb Lepore was identified as being the Boston variant, whereas in the rest of patients (9 in total), the peak identified with hybrid chain globin (db) was not present and the molecular study showed that these patients were heterozygotes for Hb Lepore Baltimore. INTERPRETATION AND CONCLUSIONS: The study of globin chains by reversed phase HPLC is sufficient to know the phenotype of Hb Lepore and thus tedious techniques such as chromatography of tryptic digestion product of db abnormal chains are not essential, a particularly important consideration in those laboratories that do not have the possibility of carrying out molecular biology studies. Neverteheless, we should continue to use a gold standard molecular biology test in cases of prenatal diagnosis because this technique is the most exact and reproducible that we have.

Chromatography, High Pressure Liquid↗
PubMedDate not supplied

[Hemoglobin O Arab in interaction with beta 0-thalassemia].

Clinical, hematologic and hemoglobin composition data on the first case of Hb 0-Arab in association with beta 0-thalassemia in Yugoslavia are reported here. The propositus was a 26-years-old female from Strumica who was admitted to the hospital for several times because of anemia, hepatosplenomegaly, occasional abdominal pains, malaise and fatigue. Laboratory results presented: Hb 10.0 g/dl, RBC 3.84.10(12)/L, PCV 0.260 l/l, MCV 68 fl, MCH 26 pg, reticulocyte count 1.8%, anisopoikilocytosis, polychromasis, numerous target cells, total bilirubin 2.1 mg/dl, (indirect 1.7 mg/dl), serum-Fe 32.3 microM/L. A starch gel electrophoresis of hemolysate provided evidence for the presence of abnormal hemoglobin (approximately 85%) and Hb F (approximately 15%); the Hb A was absent. Familial screening showed her father was heterozygous for the abnormal hemoglobin, whereas the mother was heterozygous for beta-thalassemia. In vitro biosynthesis disclosed a total absence of beta globin and reduced synthesis of beta x x and gamma globin. The alpha/beta x + gamma-globin ratio was 1.77 (normal, 1.0 + 0.1). Amino acid analysis revealed that lysine substituted for glutamic acid at the position one hundred twenty-one of the beta chain (= Hb 0-Arab or beta 121 Glu----Lys).

Adolescent↗
PubMed1967

Hemoglobin Yakina. I. Clinical and biochemical studies.

Three members of a family who have erythrocytosis and a new hemoglobin, designated hemoglobin Yakima, are described. The abnormal hemoglobin is characterized by the substitution of histidine for aspartic acid at residue 99 in the beta-chain. Of three possible structure-function relations which would account for the increased oxygen affinity of hemoglobin Yakima, only two seem likely. These are: (a) an intrachain shift in the normal relations between the F and G helices and the heme group, or (b) an effect of the substituted side chain at a region of contact between nonpolar residues of the alpha- and beta-chains which favors the oxyhemoglobin quarternary structure.

Aspartic Acid↗
PubMed1999

Evaluation of a fully automated high-performance liquid chromatography assay for hemoglobin A1c.

INTRODUCTION: Measurement of hemoglobin A1c (HbA1c) is used as an objective measure of long-term blood glucose control in diabetic patients. Recent improvements in automation combined with new recommendations for precision and accuracy have caused us to reevaluate our methods for measuring HbA1c. OBJECTIVE: We evaluated a newly automated high-performance liquid chromatography (HPLC) instrument for measurement of HbA1c (Tosoh A1c 2.2 Plus Glycohemoglobin Analyzer, Tosoh Medics, Foster City, Calif) and compared the results obtained by HPLC to those obtained with an immunoassay (Hitachi 911, Boehringer Mannheim Corporation, Indianapolis, Ind). RESULTS: The Tosoh analyzer was found to be linear in a range of 5.3% to 17% and had a throughput of 20 samples per hour. HbA1c results for 102 patient samples by the 2 techniques showed good correlation, with a slope of 0.87 and an intercept at 1.27% +/- 0.15%. Both the total and within-run coefficients of variation were consistently lower for the HPLC method compared with the immunoassay method. The HPLC method produces a chromatogram that shows the different hemoglobin fractions, allowing identification of abnormal hemoglobin variants. In heterozygous individuals, HbA1c measurements are made with no interference from the hemoglobin variant. In the case of homozygous or doubly heterozygous hemoglobin variants, the Tosoh HPLC identifies the hemoglobin variants as such and correctly does not report a HbA1c value in the presence of a markedly decreased amount of hemoglobin A. CONCLUSIONS: The Tosoh HPLC provides adequate throughput and improved precision, and the method is traceable to the Diabetes Control and Complications Trial.

Chromatography, High Pressure Liquid↗
PubMed2004

Pseudoreticulocytosis in a patient with hemoglobin Köln due to autofluorescent erythrocytes enumerated as reticulocytes by the Cell-Dyn 4000.

Pseudoreticulocytosis in a 25-year-old female patient with hemoglobin Köln is reported. The abnormal hemoglobin, hemoglobin Köln (beta chain, Val98-->Met), had previously been confirmed in the patient at the age of 21 years, as well as in her mother, by polymerase chain reaction-based direct sequence analysis of the beta globin gene. The patient underwent splenectomy at the age of 22 years. On her admission to our hospital for treatment of an immunoglobulin A nephropathy, an analysis by an automated hematology analyzer, the Abbott Cell-Dyn 4000 (CD4000), reported a marked reticulocytosis. Staining by the Brecher method with new methylene blue indicated a moderate reticulocytosis (5.7%) of a lesser extent than that indicated by the CD4000 (51.1%). The frequencies of red blood cells (RBC) with Pappenheimer bodies (13.8%), Heinz bodies (32.7%), and Howell-Jolly bodies (0.3%) were increased. The CD4000 detects RBC with RNA fluorescently stained with CD4K530 as reticulocytes. Autofluorescence of RBC with hemoglobin Köln, as we demonstrated by flow cytometry and fluorescent microscopy, was considered to have caused the pseudoreticulocytosis on the fully automated reticulocyte enumeration by the CD4000.

Adult↗
PubMed1978

[Hemoglobin Pyrgos beta 83 (EF 7) Gly leads to Asp in a Malian: structural identification and functional properties (author's transl)].

The second observation of hemoglobin Pyrogos is reported. This abnormality was initially described in a Greek family, in our case it concerns an African negro originating from the Republic of Mali. The abnormal hemoglobin was without clinical or hematological consequences. The structural defect is a substitution of an Asp for a Gly in the immediate vicinity of lysine beta 82. This leads to a large inhibition of the corresponding tryptic cleavage and therefore to difficulties in the determination of the mutation. A second feature is a slight modification occurring near one of the 2.3 DPG binding site. As a consequence, the regulatory effect of this organic phosphate is smaller in the purified and stripped component than on hemoglobin A.

Amino Acid Sequence↗