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SECTION SIX - OTHER CLINICALLY IMPORTANT DISORDERS OF HEMOGLOBIN

Published online by Cambridge University Press:  03 May 2010

Martin H. Steinberg
Affiliation:
Boston University
Bernard G. Forget
Affiliation:
Yale University, Connecticut
Douglas R. Higgs
Affiliation:
MRC Institute of Molecular Medicine, University of Oxford
David J. Weatherall
Affiliation:
Albert Einstein College of Medicine, New York
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Summary

Three chapters discuss rare inherited hemoglobinopathies including unstable hemoglobins, hemoglobins with altered oxygen affinity, hemoglobins easily oxidized, and a miscellaneous group of hemoglobin variants with interesting biological properties, some of which are clinically important. Acquired disorders of hemoglobin can arise from heme iron oxidation due to inherited abnormalities of hemoglobin-reducing enzymes or because of exposure to exogenous oxidizing agents.

Rare hemoglobinopathies have taught us much about the struc24-87519-function relationships of hemoglobin. Hemoglobin mutants have provided the most comprehensive list of mutations of any system in human biology, creating a map for understanding mutation in other genetic loci. Globin gene mutations – these include nearly every class of mutation so far described – provided an early catalog of the possible mechanisms of genetic disease.

An accounting of globin gene mutations in early 2008 listed 1,326 unique mutations (http://globin.cse.psu.edu/). Here, we discuss some rare hemoglobin mutations. As comparatively few globin residues are critical for maintaining the structural integrity and functional utility of the molecule, most hemoglobin mutations are not associated with hematological or clinical abnormalities and so escape detection. Some mutations, although not medically important, illustrate interesting biological and anthropological principles.

Abnormal hemoglobins with high or low oxygen affinity, variants that have their heme iron oxidized to the ferric form causing methemoglobinemia (HbM), or hemoglobin variants that are unstable are abnormalities seen rarely by the general physician and infrequently encountered in the practice of hematology.

Type
Chapter
Information
Disorders of Hemoglobin
Genetics, Pathophysiology, and Clinical Management
, pp. 587 - 588
Publisher: Cambridge University Press
Print publication year: 2009

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