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Presentation of Compound Heterozygous Hemoglobin Constant Spring and Hemoglobin Pakse in Neonates

Komvilaisak, Patcharee MD*; Jetsrisuparb, Arunee MD*; Fucharoen, Goonnapa MSc; Komwilaisak, Ratana MD; Jirapradittha, Junya MD*; Kiatchoosakun, Pakaphan MD*

Journal of Pediatric Hematology/Oncology: August 2019 - Volume 41 - Issue 6 - p e413–e415
doi: 10.1097/MPH.0000000000001406
Online Articles: Clinical and Laboratory Observations

Background: Mutations causing α thalassemia are divided into deletion and nondeletion groups. In the nondeletion group, hemoglobin constant spring (Hb CS) and hemoglobin Pakse (Hb Pakse) are both caused by a termination codon mutation leading to elongation of the α2 globin gene. In the case of Hb CS, the mutation is TAA→CAA, whereas the mutation causing Hb Pakse is TAA→TAT. Clinical hematologic phenotypes are not significantly different. It is important to identify compound heterozygotes for purposes of genetic counseling.

Methods: We report 5 neonates with compound heterozygous Hb CS/Hb Pakse mutations with respect to clinical courses, hematologic profiles, and management.

Results: Among 5 cases (3 male babies and 2 female babies) with mean birth weight 2982 g (range, 2660 to 3440 g), 3 were diagnosed as compound heterozygous Hb CS/Hb Pakse, 1 as homozygous Hb E with compound heterozygous Hb CS/Hb Pakse, and 1 as heterozygous Hb E with compound heterozygous Hb CS/Hb Pakse. Clinical manifestations included fetal anemia (1 case), neonatal hyperbilirubinemia (5), neonatal anemia (2), hepatosplenomegaly (1), and cholestatic jaundice (1). Three cases required a single phototherapy; 2 cases needed double phototherapy for treatment of severe hyperbilirubinemia. During the first few months of life, all cases had mild anemia, slightly low mean corpuscular volume, wide red cell distribution width, and low red cell counts. At 1 to 3 years of age, all patients still had mild microcytic hypochromic anemia with Hb levels around 10 g/dL, increased reticulocyte count, and wide red cell distribution width.

Conclusions: Misdiagnosis of Hb Pakse could occur via Hb typing using Hb electrophoresis, because the band comigrates with that of Hb CS. DNA study is the definitive method for diagnosis.

Departments of *Pediatrics

Obstetrics and Gynecology, Faculty of Medicine

Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Thailand

The authors declare no conflict of interest.

Reprints: Patcharee Komvilaisak, MD, Khon Kaen University, Muang, Khon Kaen, 40000 Thailand (e-mail:

Received April 12, 2018

Accepted December 9, 2018

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.