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GENETIK HEMATOLOGI
Dr. Tahono
Molecular biology
Application
- Prenatal diagnostic
- Pre-implantation diagnostic
- Gene therapy
- Organ culture
- Genetic alteration
THE DIAGNOSTIC ALGORITHM FOR
PROLIFERATIVE DISEASE
Clinical features
Morphology
Histochemistry/Immunohistochemistry
Immunophenotyping
human being
family
organs
cells
Protein
coded by
molecular
gene
atomic
DNA
RNA
PROTEIN
translation
protein
COMMON LEUKIMIA-ASSOCIATED
TRANSLOCATIONS AND RESULTANT FUSION GENES
AND MRNA SPECIES
Abnormality Prognostic
Significance
a. ETIOLOGY OF CML
- Philadelphia chromosome, ph1 (>95%)
- Non-philadephia chromosome (<5%)
The translocated abl gene inserts into the bcr gene. The two
genes fuse. The alteredabl gene functions improperly, resulting
CML
Leukemic blasts
Lineage
A1 CD45 ± CD45 ± CD45 ± CD45 ± CD45 ±
B CD19 ± CD19 - CD19 ± CD19 - CD19 -
B cCD79a ± cCD79a - cCD79a - cCD79a - cCD79a -
T CD7 - CD7 ± CD7 ± CD7 ± CD7 ±
T cCD3 - cCD3 ± ± cCD3 - cCD3 - cCD3 -
My/Mo MPO - MPO - MPO ± MPO - MPO -
My/Mo CD13 ± CD13 ± CD13 ± CD13 ± CD13 ±
My/Mo CD33 ± CD33 ± CD33 ± CD33 ± CD33 ±
My/Mo CD117 - CD117 - CD117 ± CD117 ± CD117 ±
Meg CD41a - CD41a - CD41a - CD41a ± CD41a -
Eryth GPA - GPA - GPA - GPA - GPA ±
- Glucose-6-phospate
- Pyruvate kinase
- Triose phosphate isomerase
- Pyrimidine-5-nucleotidase
- Glutathione synthetase
Hemoglobin defects:
- Defective synthesis
e.g thalasemia (alpha or betha)
- abnormal variants. E
e.g hb S, Hb C, unstable Hb
Hb 300 juta/sel
Heme + Globin
bilirubin
DIAGNOSIS
C. THALASSEMIA
Hemoglobinopati
KOMPOSISI HB DEWASA
HbA2(α2δ2) ~2,5%
α β
HbF (α2γ2) <1%
δ
γ
ζ ζ α α2 α1
16 3’
ε Gγ Aγ β δ β
11 3’
α δ
Polypeptide γ β
chains
α2γ2 α2δ2 α2β2
hemoglobins F A2 A
Gen α globin ζ2 α2 α1
141 asam amino Kromosom 16
Gen β globin ε Gγ Aγ δ β
Kromosom 11
146 asam
amino
Hb Gowers 1
hemoglobin
(ζ 2 ε 2)
Hb A (Mayor)
Hb Gowers 2 Hb F α2β2
(α 2 ε 2) (α2γ2)
Hb A2 (Minor)
Hb Portland α2δ2
(ζ 2 γ 2)
Masa EMBRIO JANIN DEWASA
Perkembangan
Blok 6 – Hematologi Page 15
β Thalasemia-α
δ
Kelebihan: β
SSSSSSSS
Rantai globin –γ (fetus)
γ SSSSSSSSSSSSSSS
SSSSSSSSSSSSSSS
Rantai globin –β (adult)
SSSSSSSSSSSSSSS δ
α SSSSSSSSSSSSSSS α γ
γ4 (Hb Bart)
SSSSSSSSSSSSSSS
β4 (HbH)
SSSSSSSSSSSSSSS
SSSSSSSSSSSSSSS
SSSSS SSSSSS
Presipitasi terutama di sel darah merah matang
↓
Hemolisis di sirkulasi perifer (limpa)
β
α4 (very unstable) α
δ
γ
precipitates
Marrow
Peripheral circulation
Normal
Alpha thalassemia
One gene trait, normal Hb,
deletion normal or slightly
(alpha/alpha+) reduced MCV
Two gene
deletion Normal Hb,
(alpha+/alpha+) microcytic
Two gene
deletion
(alpha/alpha 0) Hb disease, reduced Hb,
Three gene splenomegaly,
deletion (alpha transfusion dependent,
+/alpha 0) “golf ball” cellswith life
No alpha chain Three gene Incompatible
production deletion (alpha fetus dies in utero Hb
+/alpha 0) Barts
MACAM PEMERIKSAAN
1. Darah rutin:
- hgb, RBC, Hct
- Indeks eritrosit: MCV, MCH, MCHC
2. Morfologi darah tepi
3. Pengecatan supravital
4. Uji resistensi satu tabung
5. Dichlorophenol indophenols precipitation (DCIP) test
6. Fraksi HbA2
7. Fraksi HbF
8. Kadar feritin
9. Analisa Hb
10. Analisa DNA
11.
SKRINING AWAL
INDEKS ERITROSIT
MCV <= 80fl or MCH
<=26pg
Hb Hb
↓ normal
Iron status/ferritin&CRP
MDT & supravital
D. HEMOFILIA
- Defek gen/protein FVIII(A), FIX (B)\
- Bleeding tendency
- Ringan, sedang, berat
- Herediter (x-linked) atau spontan (90%)
Chromosome 12
X-
Chromosome
megakaryocyte
Endothelial cells
Liver sinusoidal cells Hepatocyte
Endothelial cells vWF subunit (Mr
Single chain form of ~220 kDa)
factor VIII transforms combines into
into two-chains form vWF protomer
vWF multimer
Factor VIII, two-chain
form, Mr ~280 kDa Mr~1-20 MDa
- analysis of DNA
- analysis of RNA
- nucleated cells
- southern blot analysis
- in situ hybridization
- flouresennce in situ hybridization (FISH)
- PCR
SOUTHERN BLOT