Hemoglobin A(2) and Heterogeneous Diagnostic Relevance Observed in Eight New Variants of the Delta Globin Gene

Background: Hemoglobin A (Hb A) (alpha(2)beta(2)) in the normal adult subject constitutes 96-98% of hemoglobin, and Hb F is normally less than 1%, while for hemoglobin A(2) (Hb A(2)) (alpha(2)delta(2)), the normal reference values are between 2.0 and 3.3%. It is important to evaluate the presence of possible delta gene mutations in a population at high risk for globin gene defects in order to correctly diagnose the beta-thalassemia carrier. Methods: The most used methods for the quantification of Hb A(2) are based on automated high performance liquid chromatography (HPLC) or capillary electrophoresis (CE). In particular Hb analyses were performed by HPLC on three dedicated devices. DNA analyses were performed according to local standard protocols. Results: Here, we described eight new delta-globin gene variants discovered and characterized in some laboratories in Northern Italy in recent years. These new variants were added to the many already known Hb A(2) variants that were found with an estimated frequency of about 1-2% during the screening tests in our laboratories. Conclusions: The knowledge recognition of the delta variant on Hb analysis and accurate molecular characterization is crucial to provide an accurate definitive thalassemia diagnosis, particularly in young subjects who would like to ask for a prenatal diagnosis or preimplantation genetic diagnosis.