Adult Onset, Chronic Anemias of Undermined Etiology, Myanmar
Qualitative and quantitative analysis of hemoglobin (Hb) was done by DEAE-HPLC and IEF in six Myanmar patients who had been diagnosed clinically and treated as chronic refractory anamia, most probably thalassemia (Thal) or hemoglobinopathy. All of them were having microcytic hypochromic type of anemia for a long duration varying from two years to more than 15 years. Hb A was detected in all cased and abnormal Hb, Hb E, was associated in four cases. Hb A2 was measured in two cases in whom Hb E was not associated and found to be 1.5% and 1.1%, respectively. Hb E was not detected in three cases but it was markedly increased in other three cases (18.4%; 21.3%; and 48.1%, respectively). Amplification refractory mutation system (ARMS) was applied for DNA analysis using five primer sets for common Thal mutations of Myanmar. Restriction enzyme assay of PCR products confirmed the associated Hb E in four cases. Compound heterozygosity of Hb E and B0 or B+ Thal allele was observed in three cases. Direct sequencing of PCR products or ARMS using additional primers sets for the Thal mutations of near by countries was suggested to obtain a better coverage of detection of Myanmar Thal mutations.
