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Clinical and Molecular Characterization of βS and Gγ(Aγδβ)0-Thalassemia in Eastern India

Fetal hemoglobin (Hb F) is the most studied modifier of sickle cell disease. Coinheritance of high Hb F determinants such as δβ-thalassemia (δβ-thal) and hereditary persistence of fetal hemoglobin (HPFH) can contribute to raised Hb F concentration in these patients. One hundred and seventy-six cases of sickle cell disease with high Hb F were screened for the presence of the Asian Indian deletion-inversion Gγ(Aγδβ)0-thal and HPFH-3 (Indian, 48.5 kb) disorders. Three cases from two unrelated families were found to have sickle cell disease and the (Aγδβ)0-thal genotype. Three other members had heterozygous Gγ(Aγδβ)0-thal. None had HPFH-3. Despite very high Hb F concentrations and linkage of the βS gene to Asian haplotypes, the compound heterozygotes had severe clinical presentation, possibly because of heterocellular distribution of Hb F. In conclusion, these high Hb F determinants are not common causes of high Hb F in Indian sickle cell disease patients.