Hemoglobin Bart's hydrops fetalis: charting the past and envisioning the future.

Autor:	Amid A; Division of Pediatric Hematology/Oncology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada., Liu S; Laboratory of Gene Regulation, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom.; Chinese Academy of Medical Sciences Oxford Institute, University of Oxford, Oxford, United Kingdom., Babbs C; Laboratory of Gene Regulation, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom., Higgs DR; Laboratory of Gene Regulation, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom.; Chinese Academy of Medical Sciences Oxford Institute, University of Oxford, Oxford, United Kingdom.
Jazyk:	angličtina
Zdroj:	Blood [Blood] 2024 Aug 22; Vol. 144 (8), pp. 822-833.
DOI:	10.1182/blood.2023023692
Abstrakt:	Abstract: Hemoglobin Bart's hydrops fetalis syndrome (BHFS) represents the most severe form of α-thalassemia, arising from deletion of the duplicated α-globin genes from both alleles. The absence of α-globin leads to the formation of nonfunctional hemoglobin (Hb) Bart's (γ4) or HbH (β4) resulting in severe anemia, tissue hypoxia, and, in some cases, variable congenital or neurocognitive abnormalities. BHFS is the most common cause of hydrops fetalis in Southeast Asia; however, owing to global migration, the burden of this condition is increasing worldwide. With the availability of intensive perinatal care and intrauterine transfusions, an increasing number of patients survive with this condition. The current approach to long-term management of survivors involves regular blood transfusions and iron chelation, a task made challenging by the need for intensified transfusions to suppress the production of nonfunctional HbH-containing erythrocytes. Although our knowledge of outcomes of this condition is evolving, it seems, in comparison to individuals with transfusion-dependent β-thalassemia, those with BHFS may face an elevated risk of complications arising from chronic anemia and hypoxia, ongoing hemolysis, iron overload, and from their respective treatments. Although stem cell transplantation remains a viable option for a select few, it is not without potential side effects. Looking ahead, potential advancements in the form of genetic engineering and innovative therapeutic approaches, such as the reactivation of embryonic α-like globin gene expression, hold promise for furthering the treatment of this condition. Prevention remains a crucial aspect of care, particularly in areas with high prevalence or limited resources. (© 2024 American Society of Hematology. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.)
Databáze:	MEDLINE
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