A Family with γ-Thalassemia and High Hb A2 Levels

We describe a family carrying a g-globin gene deletion associated with an increase of Hb A2 level beyond the normal range. The family included the proband, his sister and their father, all with increased Hb A2 and normal Hb F levels. The proband and his sister showed borderline values of mean corpuscular volume (MCV) and reduced values of mean corpuscular hemoglobin (Hb) (MCH). The proband was referred to our Medical Genetics Service for preconception counseling together with his partner, a typical b-thalassemia (b-thal) carrier. The results were negative for the most frequent a-thalassemia (a-thal) mutations, and had no significant sequence variations of the coding sequences and promoter of the b- and d-globin genes. Quantitative analysis by multiplex ligation-dependent probe amplification (MPLA) of the b-globin gene cluster detected a heterozygous deletion, ranging between 2.1 and 4.7 kb, in the proband, his sister and the father. The deletion involved the Gg gene and Gg-Ag intergenic region, whereas the 3’ region of the Ag gene was preserved. A subsequent gap-polymerase chain reaction (gap-PCR) showed that a hybrid GAg fusion gene was present. The deletion segregated with the elevation of Hb A2. The MLPA analysis of the b-globin gene cluster in 150 control alleles excluded a common polymorphism. Despite stronger evidence being needed, the described family suggests a possible role of this g-globin gene deletion in contributing to Hb A2 elevation, possibly by altering the transcription regulation of the cluster. We propose g-globin gene dosage analysis to be performed in patients with unexplained elevated Hb A2 levels