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Hemoglobin. 2019 Mar;43(2):122-125. doi: 10.1080/03630269.2019.1614048. Epub 2019 May 30.

Hb Aalesund (HBA2: c.400_406delAGCACCG), an Unstable α-Globin Variant Found in a Norwegian Patient Causing Moderate Hemolytic Anemia and Falsely High Hb A1c Using Ion Exchange High Performance Liquid Chromatography.

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a Department of Medical Biochemistry , Oslo University Hospital, Ullevaal , Oslo , Norway.
b Institute of Clinical Medicine , University of Oslo , Oslo , Norway.
c Department of Life Sciences and Health , OsloMet (Oslo Metropolitan) University , Oslo , Norway.
d Department of Endocrinology , Aalesund Hospital , Aalesund , Norway.
e Department of Medical Biochemistry , Aalesund Hospital , Aalesund , Norway.
f Department of Biological Sciences , Norwegian University of Science and Technology , Aalesund , Norway.


A new unstable hemoglobin (Hb) variant, named Hb Aalesund, was detected during Hb A1c measurement in a patient with a nearly compensated hemolytic anemia. Sequencing of the α-globin genes revealed a 7 bp deletion in exon 3 of the HBA2 gene (HBA2: c.400_406delAGCACCG) (NM_000517.4) causing a frameshift and a premature termination codon (PTC) two positions downstream. Apparently, the transcript bypassed nonsense-mediated decay (NMD), and a truncated protein was translated. The unstable Hb variant presumably underwent rapid denaturation, as heterozygosity of Hb Aalesund was associated with mild hemolytic anemia. In addition, the Hb variant interfered with Hb A1c measurement by cation exchange high performance liquid chromatography (HPLC), causing a falsely high Hb A1c result when using the Bio-Rad D10™ Hemoglobin Analyzer fast Hb A1c Program.


Hb A; hemoglobinopathy; hemolytic anemia; unstable hemoglobin (Hb); α-Globin gene

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