Thalassemias and Hemoglobin disorders
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Questions and Answers

What is the main characteristic of hemoglobin disorders?

  • Gene mutations affecting Hb production switching
  • Qualitative defects resulting from single amino acid substitutions (correct)
  • Reduced rate of synthesis of one or more globin chains
  • Quantitative defects in globin chain synthesis
  • What is the effect of the mutation in sickle cell hemoglobinopathy?

  • Increases the stability of the Hb molecule
  • Affects the stability of the Hb molecule during hypoxia (correct)
  • Decreases the oxygen affinity of the Hb molecule
  • Increases the synthesis of HbS chains
  • What is the result of homozygous occurrence of the sickle gene?

  • Severe, chronic hemolytic anemia (correct)
  • Mild anemia and hemolysis
  • Benign clinical course with no anemia
  • No effect on hemoglobin synthesis
  • What is the characteristic of thalassemias?

    <p>Quantitative defects in globin chain synthesis</p> Signup and view all the answers

    What is the effect of the substitution of glutamic acid with valine in sickle cell hemoglobinopathy?

    <p>Affects the stability of the Hb molecule during hypoxia</p> Signup and view all the answers

    What is the result of heterozygous occurrence of the sickle gene?

    <p>Benign clinical course with mild anemia and hemolysis</p> Signup and view all the answers

    What is the group of gene mutations that interfere with the switching of fetal to adult Hb production known as?

    <p>Hereditary persistence of high fetal hemoglobin (HPFH)</p> Signup and view all the answers

    What percentage of HbS is found in the red cells of individuals with sickle cell anemia?

    <p>90-100%</p> Signup and view all the answers

    What is the primary characteristic of thalassemia syndromes?

    <p>Hypochromic anemia caused by deficient synthesis of one or more polypeptide chains of hemoglobin</p> Signup and view all the answers

    Which chromosomes are involved in the production of hemoglobin?

    <p>Chromosomes 11 and 16</p> Signup and view all the answers

    What is the commonest type of β-thalassemia?

    <p>β-thalassemia trait</p> Signup and view all the answers

    What is the net result of the hemolytic component of the disease?

    <p>Removal of inclusions by the monocyte-macrophage system</p> Signup and view all the answers

    What is the result of the free α chains forming α-globin tetramers?

    <p>Unstable α-globin tetramers leading to intraerythrocytic inclusion bodies</p> Signup and view all the answers

    At what age is the onset of the disease usually seen?

    <p>Second half of the first year</p> Signup and view all the answers

    What is a characteristic of α-thalassemia?

    <p>Reduced synthesis or absent synthesis of α-globin chains</p> Signup and view all the answers

    What is the characteristic feature of blood smear in chronic hemolytic anemia?

    <p>Target cells and nucleated cells, extreme anisocytosis</p> Signup and view all the answers

    What is the genotype of a person with β-thalassemia minor?

    <p>Heterozygous</p> Signup and view all the answers

    What is the risk of thalassemia major when both parents have thalassemia trait?

    <p>25%</p> Signup and view all the answers

    What is a common manifestation of hemosiderosis?

    <p>Abnormal facies</p> Signup and view all the answers

    What is the effect of the disease on erythropoiesis?

    <p>Erythropoiesis is ineffective</p> Signup and view all the answers

    What is the minimum volume of packed RBCs required per year?

    <p>240 ml/kg/year</p> Signup and view all the answers

    What is the range of HbA2 in β-thalassemia trait?

    <p>3.4-7%</p> Signup and view all the answers

    What is a common feature of chronic hemolytic anemia?

    <p>All of the above</p> Signup and view all the answers

    What percentage of HbF is raised in chronic hemolytic anemia?

    <p>More than 90%</p> Signup and view all the answers

    Why should splenectomy be delayed until after 5-6 years of age?

    <p>To avoid overwhelming infection in young children with immature immune system</p> Signup and view all the answers

    What is the goal of blood transfusion in chronic hemolytic anemia?

    <p>To maintain Hb above 9.5 g/dl</p> Signup and view all the answers

    What is a characteristic of red blood cells in β-thalassemia trait?

    <p>Microcytic and hypochromic</p> Signup and view all the answers

    What is the most effective treatment for chronic hemolytic anemia?

    <p>Bone marrow transplantation</p> Signup and view all the answers

    What is the term for the loss of all marrow elements leading to anemia, leukopenia, and thrombocytopenia?

    <p>Pancytopenia</p> Signup and view all the answers

    What is the term for a marked decrease or absence of blood-forming elements in the bone marrow?

    <p>Aplastic anemia</p> Signup and view all the answers

    What is the characteristic feature of Fanconi anemia?

    <p>Short stature, skin hyperpigmentation, and skeletal abnormalities</p> Signup and view all the answers

    What is the primary goal of general care in pancytopenia?

    <p>To isolate the patient and provide fresh air</p> Signup and view all the answers

    What is a common complication of pancytopenia?

    <p>All of the above</p> Signup and view all the answers

    What is the only curative therapy for pancytopenia?

    <p>Bone marrow transplantation</p> Signup and view all the answers

    What is a characteristic laboratory finding in pancytopenia?

    <p>Low HB level and RBCs</p> Signup and view all the answers

    What is a possible treatment for pancytopenia if bone marrow transplantation is not available?

    <p>All of the above</p> Signup and view all the answers

    What is a characteristic feature of acquired pancytopenia?

    <p>Manifestation of the underlying cause</p> Signup and view all the answers

    What is a common cause of acquired pancytopenia?

    <p>Drugs and chemicals</p> Signup and view all the answers

    Study Notes

    Hemoglobin Disorders

    • Hemoglobin disorders are qualitative defects resulting from single amino acid substitution in the alpha or beta chains of adult hemoglobin.
    • These defects affect the stability of the Hb molecule and alter its oxygen affinity.

    Structural Hemoglobin Variants

    • These are qualitative defects that result from single amino acid substitution in the alpha or beta chains of adult hemoglobin.
    • Examples include sickle cell hemoglobinopathy.

    Sickle Cell Hemoglobinopathy

    • Characterized by a structural defect of β chains of hemoglobin where glutamic acid in position number 6 is replaced by valine (α2-β2 6 val).
    • This minor defect affects the stability of the Hb molecule during hypoxia, distorting the red cell membrane and forming sickled cells.

    Sickle Cell Anemia

    • Homozygous occurrence of the sickle gene with two abnormal genes results in severe, chronic hemolytic anemia.
    • Heterozygous occurrence of the sickle gene (one abnormal gene) has red cells containing 35-45% Hb S, usually with a benign clinical course with mild anemia and hemolysis.

    Thalassemias

    • A heterogeneous group of inherited disorders characterized by hypochromic anemia caused by deficient synthesis of one or more of the polypeptide chains of human Hb.
    • Two hemoglobin gene clusters are involved in the production of Hb and are located on chromosomes 11 and 16.

    β-Thalassemia

    • Decrease in the formation of β chains (HbA) with the formation of γ chains (HbF) and δ chains (HbA2) to compensate for the deficiency of adult Hb.
    • Four grades of β thalassemia:
      • Silent carrier (asymptomatic)
      • β-thalassemia trait (mild anemia)
      • β-thalassemia intermedia (moderate anemia)
      • β-thalassemia major (hydrops fetalis)

    α-Thalassemia

    • Disorders caused by reduced synthesis or absent synthesis of α globin chains.
    • Four clinical types:
      • Hemoglobin H disease
      • β-thalassemia minor
      • α-thalassemia trait
      • α-thalassemia major

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    Description

    Learn about the inherited disorders of thalassemias, characterized by hypochromic anemia and deficient synthesis of hemoglobin polypeptide chains.

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