Evaluation of the Presence and Types of Acquired Hemoglobinopathies in Leukemias

Introduction: Leukemias constitute 3% of the global cancer burden and presents with myriad of symptoms including anemia. Although hemoglobinopathies are nearly always inherited, persons with previously normal hematologic function may develop aberrant hemoglobin synthesis as an acquired abnormality, especially within the context of hematologic malignancies. Objective: To study the association between Acquired Hemoglobinopathies and Leukemias. Materials and methods: The subjects were newly/previously diagnosed cases of leukemias, both chronic and acute and myeloid as well as lymphoid. Complete workup included CBC, complete iron profile, Vitamin B12/Folate assays, Liver function tests, supra vital staining and histochemical stains (Sudan Black B and Periodic Acid Schiff). All cases were subjected to High Performance Liquid Chromatography. Patients presenting with Leukemoid reaction were taken as controls. All those with any congenital haemoglobinopathy either in patient or family, those already on cytotoxic treatment and those with a positive Direct Antiglobulin Test were excluded. Results: We included 56 cases and 22 age and sex matched controls. The mean age of cases was 31.3 years with a M:F of 1.4:1. 17 cases were of Acute Lymphoblastic leukemia, 18 cases of Acute Myeloid Leukemia, 13 cases of Chronic Myeloid Leukemia, 7 cases of Chronic Lymphoid Leukemia and 1 case of Myelodysplastic syndrome. Out of the 35 cases of Acute Leukemias, 17 cases showed evidence of Beta thalassemia and 4 cases of alpha thalassemia whereas rest of the 14 had normal electrophoretic findings. None of the cases of chronic leukemias or controls had abnormal electrophoretic findings. The mean values of HbA and HbF were significantly different in Acute leukemics compared to the 2 Chronic leukemics and controls. [p=0.00139] Conclusion: Acute Haematological malignancies showed a significant predisposition towards development of acquired hemoglobinopathies especially beta thalassemia as compared to chronic ones. Hence, all such cases should also be screened for hemoglobinopathies.