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Unusual C- and A2-Window Peaks (Hemoglobin M-Saskatoon) in Three North Indian Patients

  • Ojas Gupta
  • Sanjeev Chhabra
  • Jasbir Kaur
  • Reena Das
  • Deepak Bansal
  • Pankaj Malhotra
  • Prashant SharmaEmail author
Correspondence
  • 7 Downloads

Dear Sir,

We read with interest the report by Dass et al. [1] wherein they concluded that CE-HPLC-derived C-window peaks in north Indian patients only rarely represent HbC. In their findings, all four non-HbC C-window peaks were due to a hybrid HbQIndia + HbDPunjab, a finding also previously reported by us [2]. We would now like to add three cases of HbM-Saskatoon, an unusual methemoglobinemic variant, to the differential diagnosis of variant hemoglobins that result in C-window peaks.

Our first two cases were a father-son duo. The 1.5-year-old boy ( Case 1) born from a non-consanguineous marriage was reportedly healthy at birth with a normal birth weight and no obvious congenital anomalies. He was referred to our center for febrile seizures. On examination, central cyanosis, mild pallor and jaundice were noted. Liver was just palpable while the spleen was non-palpable. Cardiovascular and respiratory system evaluations were normal. Hemogram data is presented in Table  1. Blood film...

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical Approval

All procedures performed in this report involving a human participant were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This is a purely observational report and no research procedure was done.

Informed Consent

Informed consent has been obtained for this manuscript.

References

  1. 1.
    Dass J et al (2018) C-window peaks on CE-HPLC are extremely rare in northern india, and only infrequently represent HbC. Indian J Hematol Blood Transfus 34(1):91–96CrossRefGoogle Scholar
  2. 2.
    Badyal RK, Chhabra S, Sharma P, Das R (2014) An intriguing high performance liquid chromatogram of a double heterozygosity for Hb Q-India/Hb D-Punjab. Hemoglobin 38(6):440–443CrossRefGoogle Scholar
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    Kumar GV, Sharma P, Chhabra S, Hira JK, Trehan A, Das R (2015) Hb M-Iwate in an Indian family. Clin Chim Acta 15(446):192–194CrossRefGoogle Scholar
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    Benz EJ, Ebert BL (2013) Hemoglobin variants associated with hemolytic anemia, altered oxygen affinity, and methemoglobinemias. In: Hoffman R et al (eds) Hematology basic principles and practice, 6th edn. Elsevier Saunders 3, PhiladelphiaGoogle Scholar
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    Kedar PS et al (2005) Congenital methemoglobinemia caused by Hb-MRatnagiri (beta-63CAT → TAT, His → Tyr) in an Indian family. Am J Hematol 79(2):168–170CrossRefGoogle Scholar

Copyright information

© Indian Society of Hematology and Blood Transfusion 2018

Authors and Affiliations

  1. 1.Department of Hematology, Level 5, Research Block APostgraduate Institute of Medical Education and ResearchChandigarhIndia
  2. 2.Pediatric Hemato-Oncology Unit, Advanced Pediatric CentrePostgraduate Institute of Medical Education and ResearchChandigarhIndia
  3. 3.Adult Clinical Hematology Unit, Department of Internal MedicinePostgraduate Institute of Medical Education and ResearchChandigarhIndia

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