Frequência da Talassemia Alfa – Deleções 3.7kb e 4.2kb em indivíduos da Região Metropolitana de Manaus - Amazonas

Detalhes bibliográficos
Ano de defesa: 2019
Autor(a) principal: Anselmo, Fernanda Cozendey
Orientador(a): Não Informado pela instituição
Banca de defesa: Não Informado pela instituição
Tipo de documento: Dissertação
Tipo de acesso: Acesso aberto
Idioma: por
Instituição de defesa: Universidade do Estado do Amazonas
Brasil
UEA
PROGRAMA DE PÓS-GRADUAÇÃO EM CIÊNCIAS APLICADAS À HEMATOLOGIA
Programa de Pós-Graduação: Não Informado pela instituição
Departamento: Não Informado pela instituição
País: Não Informado pela instituição
Palavras-chave em Português:
Link de acesso: https://ri.uea.edu.br/handle/riuea/2234
Resumo: Alpha thalassemia, one of the most common monogenic diseases in the world, is a heterogeneous group of hereditary changes caused by those who affect the alpha (α) regulatory genes and promote imbalance in the market in hemoglobin levels due to the loss of one or more α genes. The 3.7Kb deletion is the most frequent worldwide and, in Brazil, varied 20 and 35%, while it is mainly concentrated, being more predominant in Afro-descendants. A major cross-sectional study was carried out with the aim of characterizing an alpha thalassemia, comprising -α3.7 and -α4.2 deletions, estimating its frequency in a case of the Metropolitan Region of Manaus-Amazonas. The deletion was investigated by GAP-PCR for -α3.7 and Multiplex-PCR for -α4.2. The sample size included 2798 municipalities of the region, comprising the cities of Iranduba (N = 232), Itacoatiara (N = 301), Manacapuru (N = 287), Presidente Figueiredo (N = 370), Coari (N = 263) and the capital, Manaus (N = 1345). The samples were collected from hospitals and/or health centers in each city. Specifically, in Manaus, the samples were stratified between care at health centers (N = 356) and a specific group of blood donors seen at FHEMOAM (N = 989). All samples were submitted to the hemogram and by the dosage of Ferritin and Serum Iron (Bioclin® KIT). DNA extraction was performed using Biopur Mini Spin Plus kit, stored at -20°C and further processed. Alpha thalassemia was found in 7.9% of the general population (6.0% heterozygous and 1.9% homozygous), as the variables analyzed among the patients were statistically significant (<0.001) among hematological parameters, except between Serum iron and Ferritin dosages. In this group, 158 microcytic and hypochromic subjects were found, with a frequency of 40.68%. The prevalence of -α3.7 was 5.35% in blood donors. The number of leukocytes and platelet counts did not differ significantly. As might be expected, hematological data were more reduced, considering an average among normal individuals (p <.001). This is a study that presents values of hematological parameters, especially MCV and HCM are lower in donors with iron deficiency, while when associated with α-thalassemia and may be useful in discriminating different types of microcytic anemia. In conclusion, we believe that screening for the thalassemia trait should be built on genetic and at the same time prenatal databases, as well as the existence of a standard blood test prior to donating blood. It should be noted the first study to perform a screening of alpha deletions in the general population and blood donors of the Manaus region
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spelling Frequência da Talassemia Alfa – Deleções 3.7kb e 4.2kb em indivíduos da Região Metropolitana de Manaus - AmazonasAlpha Thalassemia Frequency – 3.7kb and 4.2kb Deletions in Individuals from the Region Metropolitan of Manaus - AmazonasHemoglobinopatiasTalassemia AlfaGAP-PCRBiologia MolecularHemoglobinopathiesMolecular biologyAlpha thalassemia, one of the most common monogenic diseases in the world, is a heterogeneous group of hereditary changes caused by those who affect the alpha (α) regulatory genes and promote imbalance in the market in hemoglobin levels due to the loss of one or more α genes. The 3.7Kb deletion is the most frequent worldwide and, in Brazil, varied 20 and 35%, while it is mainly concentrated, being more predominant in Afro-descendants. A major cross-sectional study was carried out with the aim of characterizing an alpha thalassemia, comprising -α3.7 and -α4.2 deletions, estimating its frequency in a case of the Metropolitan Region of Manaus-Amazonas. The deletion was investigated by GAP-PCR for -α3.7 and Multiplex-PCR for -α4.2. The sample size included 2798 municipalities of the region, comprising the cities of Iranduba (N = 232), Itacoatiara (N = 301), Manacapuru (N = 287), Presidente Figueiredo (N = 370), Coari (N = 263) and the capital, Manaus (N = 1345). The samples were collected from hospitals and/or health centers in each city. Specifically, in Manaus, the samples were stratified between care at health centers (N = 356) and a specific group of blood donors seen at FHEMOAM (N = 989). All samples were submitted to the hemogram and by the dosage of Ferritin and Serum Iron (Bioclin® KIT). DNA extraction was performed using Biopur Mini Spin Plus kit, stored at -20°C and further processed. Alpha thalassemia was found in 7.9% of the general population (6.0% heterozygous and 1.9% homozygous), as the variables analyzed among the patients were statistically significant (<0.001) among hematological parameters, except between Serum iron and Ferritin dosages. In this group, 158 microcytic and hypochromic subjects were found, with a frequency of 40.68%. The prevalence of -α3.7 was 5.35% in blood donors. The number of leukocytes and platelet counts did not differ significantly. As might be expected, hematological data were more reduced, considering an average among normal individuals (p <.001). This is a study that presents values of hematological parameters, especially MCV and HCM are lower in donors with iron deficiency, while when associated with α-thalassemia and may be useful in discriminating different types of microcytic anemia. In conclusion, we believe that screening for the thalassemia trait should be built on genetic and at the same time prenatal databases, as well as the existence of a standard blood test prior to donating blood. It should be noted the first study to perform a screening of alpha deletions in the general population and blood donors of the Manaus regionA Talassemia Alfa, considerada uma das doenças monogênicas mais comuns no mundo, constitui um grupo heterogêneo de alterações hereditárias causadas por deleções que afetam os genes reguladores alfa (α) e promovem o desequilíbrio no conteúdo quantitativo de globinas, culminando na diminuição de componentes normais dos níveis de hemoglobina devido à perda de um ou mais genes α. A deleção de 3,7Kb é a mais frequente em todo o mundo e, no Brasil, a prevalência varia entre 20 e 35%, dependendo principalmente da raça, sendo mais predominante nos afrodescendentes. Um estudo transversal de prevalência foi realizado com o objetivo de caracterizar a Talassemia Alfa, compreendendo as deleções -α3.7 e -α4.2, estimando sua frequência em indivíduos da Região Metropolitana de Manaus-Amazonas. A deleção foi investigada por GAP-PCR para -α3.7 e Multiplex-PCR para -α4.2. O tamanho amostral incluiu 2798 indivíduos de seis municípios da região, compreendendo as cidades de Iranduba (N = 232), Itacoatiara (N = 301), Manacapuru (N = 287), Presidente Figueiredo (N = 370), Coari (N = 263) e a capital, Manaus (N = 1345). Todas as amostras foram coletadas de hospitais e/ou centros de saúde de cada cidade. Especificamente em Manaus, as amostras foram estratificadas entre indivíduos atendidos em centros de saúde (N = 356) e um grupo específico de doadores de sangue atendidos no HEMOAM (N = 989). Todas as amostras foram submetidas ao hemograma (por meio do contador automático ABX Pentra XL 80 HORIBA) e dosagem de Ferritina e Ferro Sérico (Bioclin® KIT). A extração de DNA foi realizada utilizando kit Biopur Mini Spin Plus, armazenado a -20°C e processado gradativamente. A Talassemia Alfa foi encontrada em 7,9% da população geral (6% heterozigotos e 1,9% homozigotos), as associações analisadas entre os portadores foram estatisticamente significantes (<.001) entre os parâmetros hematológicos, exceto entre as dosagem de Ferro Sérico e Ferritina. Nesse grupo, foi encontrado 158 indivíduos microcíticos e hipocrômicos, a frequência da deleção nesse grupo alcançou 40,68%. A prevalência da -α3.7 foi de 5,35% nos doadores de sangue. O número de leucócitos e contagem de plaquetas não diferiu significativamente. Como de se esperar, os dados hematológicos dessa população foram mais reduzidos, considerando a comparação entre os indivíduos normais (p<.001). Este estudo mostrou que os valores dos parâmetros hematológicos, especialmente MCV e MCH são menores em doadores com deficiência de ferro, especialmente quando associado com α-talassemia e pode ser útil em discriminar os diferentes tipos de anemia microcítica. Em conclusão, acreditamos que a triagem para traço de talassemia deve constituir o rol de análises solicitadas em aconselhamento genético e até mesmo pré-natal, assim como a existência de um teste de sangue padrão antes da doação de sangue. Deve ser notado que este foi o primeiro estudo a realizar a triagem de deleções alfa na população geral e em doadores de sangue da região de ManausUniversidade do Estado do AmazonasBrasilUEAPROGRAMA DE PÓS-GRADUAÇÃO EM CIÊNCIAS APLICADAS À HEMATOLOGIAMoura Neto, osé Pereira dePassos, Leny Nascimento da MottaTarragô, Andréa MonteiroAnselmo, Fernanda Cozendey2022-08-10T16:22:19Z2024-09-05T18:56:19Z2022-07-292022-08-10T16:22:19Z2019-03-28info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisapplication/pdfhttps://ri.uea.edu.br/handle/riuea/2234por1. Cançado RD. Talassemias alfa Alpha thalassemias Rodolfo. Rev. Bras. Hematol. Hemoter. 2006;28(2)81-87. 2. Koza K. Hemoglobinopathies and thalasemias – genetic basis and molecular diagnosis. 2012;(7):589–94. 3. Koury MJ, Sheftel AD, Ponka P. Erythropoiesis, Hemoglobin Synthesis, and Erythroid Mitochondrial Iron Homeostasis. Handb Porphyr Sci (Volume 27). 2013; 27:41–84. 4. Goh S, Lee YT, Bhanu N V, Cam MC, Desper R, Martin BM, et al. A newly discovered human globin gene. Platelets. 2005;106(4):1466–72. 5. Higgs DR, Weatherall DJ. The Alpha Thalassaemias. Cell Mol Life Sci. 2009;66(7):1154–62. 6. Dotto FRC. Talassemias alfa e beta: revisão [Internet]. 2005. Available from: http://repositorio.ufsm.br/bitstream/handle/1/1564/Dotto_Fatima_Rosane_Colpo.pdf?se quence=1&isAllowed=y (Acesso em 21/05/2018). 7. Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. Harrison’s Principles of Internal Medicine. Star. 2015. 2958 p. 8. Spier C. Wintrobeʼs Atlas of Clinical Hematology. Am J Surg Pathol. 2008;32:1428. 9. Harteveld CL, Higgs DR, Petrou M, Brugiatelli M, Old J, Hurley P, et al. Α- Thalassaemia. Orphanet J Rare Dis. 2010;5(1):13. 10. Ribeiro DM, Sonati MF. Regulation of human alpha-globin gene expression and alpha-thalassemia. Vol. 7, Genetics and Molecular Research. 2008. p. 1045–53. 11. Li CK. New trend in the epidemiology of thalassaemia. Best. Pract. Res. Clin. Obstet. Gynaecol. 2017;39:16–26. 12. Hardison RC. Evolution of Hemoglobin and Its Genes. 2012;1–18. 52 13. Baysal E, Huisman THJ. Detection of common deletional α-thalassemia-2 determinants by PCR. Am J Hematol. 1994;46(3):208–13. 14. Chong SS, Boehm CD, Higgs DR, et al. A rapid and reliable 7-deletion multiplex polymerase chain reaction assay for a-thalassemia. Blood, vol. 98, no. 1, pp. 250-251, 2001. 15. Karen DF. Clinical evaluation of hemoglobinopathies: Part I. Thalassemia. The Warde Medical Laboratory Article Archives. 2003; 14 (2). 16. Higgs D R, Goodburn S E Y, Lamb J, Clegg J B and weatherall DJ. alpha- Thalassemia caused by a polyadenylation signal mutation. Nature. 1983; 306: 398- 400. 17. Cürük, MA, Kiline Y, Evrüke C, Ozgünen FT, Akosy K and Yüregir, GT. Prenatal diagnosis of Hb H disease caused by a homozygosity for the α2 polyA (AATAAA>AATAAG) mutation. Hemoglobin. 2001; 25: 255-258. 18. Foglietta E, Deidda G, Graziani B, Modiano G, Bianco I. Detection of α-globin gene disorders by a simple PCR methodology. Haematologica. 1996;81(5):387–96. 19. Wagner SC, Silvestri MC, Bittar CM, Friedrisch JR, Silla LMR, Para C. Prevalence of thalassemias and variant hemoglobins in patients with non-ferropenic anemia. bras hematol hemoter. 2005;27(1):37–42. 20. Organization Health W. Thalassaemia and other haemoglobinopathies. 2006. http://apps.who.int/gb/archive/pdf_files/EB118/B118_5-en.pdf (Acesso em 20/01/2019). 21. Hardison RC. Evolution of Hemoglobin and Its Genes. 2012;1–18 22. Sankar VH, Arya V, Tewari D, Gupta UR, Pradhan M. Genotyping of alpha- thalassemia in microcytic hypochromic anemia patients from North India. 2006;47(4):391–5. 23. Arezo Karamzade, Hadi Mirzapour, Majid Hoseinzade, Sara Asadi, Tahere Gholamrezapour PT& MS. α-Globin Gene Mutations in Isfahan Province, Iran. Int. J. Hemoglobin. Res. 2014;38(3). 24. Manning LR, Russell JE, Padovan JC, Chait BT, Popowicz A, Manning RS, et al. Human embryonic, fetal, and adult hemoglobins have different subunit interface strengths. Correlation with lifespan in the red cell. Protein Sci. 2007;16(8):1641–58. 25. César F, Xavier C, César F, Xavier C. Tese de Doutorado Migrações Internacionais na Amazônia Brasileira : Impactos na Política Migratória e na Política Externa. 2012. 26. Amaz RV. Revista Veredas Amazônicas – Nov – no 01, vol i, 2011. issn: 2237- 53 4043. 2011;I(V). 27. Belchior M, Brasileiro I. Características Étnico-raciais da população: Classificações e Identidades. Instituto Brasileiro de Geografia e Estatística (IBGE). https://www.ibge.gov.br/ (Acesso em 10/11/2018). 28. Nunes D, Galvani CM, Pegoraro PP, Sucena TA, Barril N. Prevalence and Epidemiological Aspects of Patients with Hemoglobinopathies in a Genetic Counseling Outpatient Clinic. 2017;11(1):100–3. 29. Sonati MF. High prevalence of alpha-thalassemia among individuals with microcytosis and hypochromia without anemia. Brazilian. J. Med. Biol. Res. 2001. 30. Carlos AM, Souza RAV, Souza BMB de, Pereira G de A, Tostes Júnior S, Martins PRJ, et al. Hemoglobinopathies in newborns in the southern region of the Triângulo Mineiro, Brazil. Cross-sectional study. Sao Paulo Med. J. 2015;133(5):439–44. 31. Adorno E., Couto F., Moura Neto JP, Menezes J., Rêgo M, Reis M, et al. Hemoglobinopathies in newborns from Salvador, Bahia, Northeast Brazil. Cad. Saúde Pública. 2005;21(1):292–8info:eu-repo/semantics/openAccessreponame:Repositório Institucional da Universidade do Estado do Amazonas (UEA)instname:Universidade do Estado do Amazonas (UEA)instacron:UEA2024-09-25T21:24:19Zoai:ri.uea.edu.br:riuea/2234Repositório InstitucionalPUBhttps://ri.uea.edu.br/server/oai/requestbibliotecacentral@uea.edu.bropendoar:2024-09-25T21:24:19Repositório Institucional da Universidade do Estado do Amazonas (UEA) - Universidade do Estado do Amazonas (UEA)false
dc.title.none.fl_str_mv Frequência da Talassemia Alfa – Deleções 3.7kb e 4.2kb em indivíduos da Região Metropolitana de Manaus - Amazonas
Alpha Thalassemia Frequency – 3.7kb and 4.2kb Deletions in Individuals from the Region Metropolitan of Manaus - Amazonas
title Frequência da Talassemia Alfa – Deleções 3.7kb e 4.2kb em indivíduos da Região Metropolitana de Manaus - Amazonas
spellingShingle Frequência da Talassemia Alfa – Deleções 3.7kb e 4.2kb em indivíduos da Região Metropolitana de Manaus - Amazonas
Anselmo, Fernanda Cozendey
Hemoglobinopatias
Talassemia Alfa
GAP-PCR
Biologia Molecular
Hemoglobinopathies
Molecular biology
title_short Frequência da Talassemia Alfa – Deleções 3.7kb e 4.2kb em indivíduos da Região Metropolitana de Manaus - Amazonas
title_full Frequência da Talassemia Alfa – Deleções 3.7kb e 4.2kb em indivíduos da Região Metropolitana de Manaus - Amazonas
title_fullStr Frequência da Talassemia Alfa – Deleções 3.7kb e 4.2kb em indivíduos da Região Metropolitana de Manaus - Amazonas
title_full_unstemmed Frequência da Talassemia Alfa – Deleções 3.7kb e 4.2kb em indivíduos da Região Metropolitana de Manaus - Amazonas
title_sort Frequência da Talassemia Alfa – Deleções 3.7kb e 4.2kb em indivíduos da Região Metropolitana de Manaus - Amazonas
author Anselmo, Fernanda Cozendey
author_facet Anselmo, Fernanda Cozendey
author_role author
dc.contributor.none.fl_str_mv Moura Neto, osé Pereira de
Passos, Leny Nascimento da Motta
Tarragô, Andréa Monteiro
dc.contributor.author.fl_str_mv Anselmo, Fernanda Cozendey
dc.subject.por.fl_str_mv Hemoglobinopatias
Talassemia Alfa
GAP-PCR
Biologia Molecular
Hemoglobinopathies
Molecular biology
topic Hemoglobinopatias
Talassemia Alfa
GAP-PCR
Biologia Molecular
Hemoglobinopathies
Molecular biology
description Alpha thalassemia, one of the most common monogenic diseases in the world, is a heterogeneous group of hereditary changes caused by those who affect the alpha (α) regulatory genes and promote imbalance in the market in hemoglobin levels due to the loss of one or more α genes. The 3.7Kb deletion is the most frequent worldwide and, in Brazil, varied 20 and 35%, while it is mainly concentrated, being more predominant in Afro-descendants. A major cross-sectional study was carried out with the aim of characterizing an alpha thalassemia, comprising -α3.7 and -α4.2 deletions, estimating its frequency in a case of the Metropolitan Region of Manaus-Amazonas. The deletion was investigated by GAP-PCR for -α3.7 and Multiplex-PCR for -α4.2. The sample size included 2798 municipalities of the region, comprising the cities of Iranduba (N = 232), Itacoatiara (N = 301), Manacapuru (N = 287), Presidente Figueiredo (N = 370), Coari (N = 263) and the capital, Manaus (N = 1345). The samples were collected from hospitals and/or health centers in each city. Specifically, in Manaus, the samples were stratified between care at health centers (N = 356) and a specific group of blood donors seen at FHEMOAM (N = 989). All samples were submitted to the hemogram and by the dosage of Ferritin and Serum Iron (Bioclin® KIT). DNA extraction was performed using Biopur Mini Spin Plus kit, stored at -20°C and further processed. Alpha thalassemia was found in 7.9% of the general population (6.0% heterozygous and 1.9% homozygous), as the variables analyzed among the patients were statistically significant (<0.001) among hematological parameters, except between Serum iron and Ferritin dosages. In this group, 158 microcytic and hypochromic subjects were found, with a frequency of 40.68%. The prevalence of -α3.7 was 5.35% in blood donors. The number of leukocytes and platelet counts did not differ significantly. As might be expected, hematological data were more reduced, considering an average among normal individuals (p <.001). This is a study that presents values of hematological parameters, especially MCV and HCM are lower in donors with iron deficiency, while when associated with α-thalassemia and may be useful in discriminating different types of microcytic anemia. In conclusion, we believe that screening for the thalassemia trait should be built on genetic and at the same time prenatal databases, as well as the existence of a standard blood test prior to donating blood. It should be noted the first study to perform a screening of alpha deletions in the general population and blood donors of the Manaus region
publishDate 2019
dc.date.none.fl_str_mv 2019-03-28
2022-08-10T16:22:19Z
2022-07-29
2022-08-10T16:22:19Z
2024-09-05T18:56:19Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/masterThesis
format masterThesis
status_str publishedVersion
dc.identifier.uri.fl_str_mv https://ri.uea.edu.br/handle/riuea/2234
url https://ri.uea.edu.br/handle/riuea/2234
dc.language.iso.fl_str_mv por
language por
dc.relation.none.fl_str_mv 1. Cançado RD. Talassemias alfa Alpha thalassemias Rodolfo. Rev. Bras. Hematol. Hemoter. 2006;28(2)81-87. 2. Koza K. Hemoglobinopathies and thalasemias – genetic basis and molecular diagnosis. 2012;(7):589–94. 3. Koury MJ, Sheftel AD, Ponka P. Erythropoiesis, Hemoglobin Synthesis, and Erythroid Mitochondrial Iron Homeostasis. Handb Porphyr Sci (Volume 27). 2013; 27:41–84. 4. Goh S, Lee YT, Bhanu N V, Cam MC, Desper R, Martin BM, et al. A newly discovered human globin gene. Platelets. 2005;106(4):1466–72. 5. Higgs DR, Weatherall DJ. The Alpha Thalassaemias. Cell Mol Life Sci. 2009;66(7):1154–62. 6. Dotto FRC. Talassemias alfa e beta: revisão [Internet]. 2005. Available from: http://repositorio.ufsm.br/bitstream/handle/1/1564/Dotto_Fatima_Rosane_Colpo.pdf?se quence=1&isAllowed=y (Acesso em 21/05/2018). 7. Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. Harrison’s Principles of Internal Medicine. Star. 2015. 2958 p. 8. Spier C. Wintrobeʼs Atlas of Clinical Hematology. Am J Surg Pathol. 2008;32:1428. 9. Harteveld CL, Higgs DR, Petrou M, Brugiatelli M, Old J, Hurley P, et al. Α- Thalassaemia. Orphanet J Rare Dis. 2010;5(1):13. 10. Ribeiro DM, Sonati MF. Regulation of human alpha-globin gene expression and alpha-thalassemia. Vol. 7, Genetics and Molecular Research. 2008. p. 1045–53. 11. Li CK. New trend in the epidemiology of thalassaemia. Best. Pract. Res. Clin. Obstet. Gynaecol. 2017;39:16–26. 12. Hardison RC. Evolution of Hemoglobin and Its Genes. 2012;1–18. 52 13. Baysal E, Huisman THJ. Detection of common deletional α-thalassemia-2 determinants by PCR. Am J Hematol. 1994;46(3):208–13. 14. Chong SS, Boehm CD, Higgs DR, et al. A rapid and reliable 7-deletion multiplex polymerase chain reaction assay for a-thalassemia. Blood, vol. 98, no. 1, pp. 250-251, 2001. 15. Karen DF. Clinical evaluation of hemoglobinopathies: Part I. Thalassemia. The Warde Medical Laboratory Article Archives. 2003; 14 (2). 16. Higgs D R, Goodburn S E Y, Lamb J, Clegg J B and weatherall DJ. alpha- Thalassemia caused by a polyadenylation signal mutation. Nature. 1983; 306: 398- 400. 17. Cürük, MA, Kiline Y, Evrüke C, Ozgünen FT, Akosy K and Yüregir, GT. Prenatal diagnosis of Hb H disease caused by a homozygosity for the α2 polyA (AATAAA>AATAAG) mutation. Hemoglobin. 2001; 25: 255-258. 18. Foglietta E, Deidda G, Graziani B, Modiano G, Bianco I. Detection of α-globin gene disorders by a simple PCR methodology. Haematologica. 1996;81(5):387–96. 19. Wagner SC, Silvestri MC, Bittar CM, Friedrisch JR, Silla LMR, Para C. Prevalence of thalassemias and variant hemoglobins in patients with non-ferropenic anemia. bras hematol hemoter. 2005;27(1):37–42. 20. Organization Health W. Thalassaemia and other haemoglobinopathies. 2006. http://apps.who.int/gb/archive/pdf_files/EB118/B118_5-en.pdf (Acesso em 20/01/2019). 21. Hardison RC. Evolution of Hemoglobin and Its Genes. 2012;1–18 22. Sankar VH, Arya V, Tewari D, Gupta UR, Pradhan M. Genotyping of alpha- thalassemia in microcytic hypochromic anemia patients from North India. 2006;47(4):391–5. 23. Arezo Karamzade, Hadi Mirzapour, Majid Hoseinzade, Sara Asadi, Tahere Gholamrezapour PT& MS. α-Globin Gene Mutations in Isfahan Province, Iran. Int. J. Hemoglobin. Res. 2014;38(3). 24. Manning LR, Russell JE, Padovan JC, Chait BT, Popowicz A, Manning RS, et al. Human embryonic, fetal, and adult hemoglobins have different subunit interface strengths. Correlation with lifespan in the red cell. Protein Sci. 2007;16(8):1641–58. 25. César F, Xavier C, César F, Xavier C. Tese de Doutorado Migrações Internacionais na Amazônia Brasileira : Impactos na Política Migratória e na Política Externa. 2012. 26. Amaz RV. Revista Veredas Amazônicas – Nov – no 01, vol i, 2011. issn: 2237- 53 4043. 2011;I(V). 27. Belchior M, Brasileiro I. Características Étnico-raciais da população: Classificações e Identidades. Instituto Brasileiro de Geografia e Estatística (IBGE). https://www.ibge.gov.br/ (Acesso em 10/11/2018). 28. Nunes D, Galvani CM, Pegoraro PP, Sucena TA, Barril N. Prevalence and Epidemiological Aspects of Patients with Hemoglobinopathies in a Genetic Counseling Outpatient Clinic. 2017;11(1):100–3. 29. Sonati MF. High prevalence of alpha-thalassemia among individuals with microcytosis and hypochromia without anemia. Brazilian. J. Med. Biol. Res. 2001. 30. Carlos AM, Souza RAV, Souza BMB de, Pereira G de A, Tostes Júnior S, Martins PRJ, et al. Hemoglobinopathies in newborns in the southern region of the Triângulo Mineiro, Brazil. Cross-sectional study. Sao Paulo Med. J. 2015;133(5):439–44. 31. Adorno E., Couto F., Moura Neto JP, Menezes J., Rêgo M, Reis M, et al. Hemoglobinopathies in newborns from Salvador, Bahia, Northeast Brazil. Cad. Saúde Pública. 2005;21(1):292–8
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Universidade do Estado do Amazonas
Brasil
UEA
PROGRAMA DE PÓS-GRADUAÇÃO EM CIÊNCIAS APLICADAS À HEMATOLOGIA
publisher.none.fl_str_mv Universidade do Estado do Amazonas
Brasil
UEA
PROGRAMA DE PÓS-GRADUAÇÃO EM CIÊNCIAS APLICADAS À HEMATOLOGIA
dc.source.none.fl_str_mv reponame:Repositório Institucional da Universidade do Estado do Amazonas (UEA)
instname:Universidade do Estado do Amazonas (UEA)
instacron:UEA
instname_str Universidade do Estado do Amazonas (UEA)
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institution UEA
reponame_str Repositório Institucional da Universidade do Estado do Amazonas (UEA)
collection Repositório Institucional da Universidade do Estado do Amazonas (UEA)
repository.name.fl_str_mv Repositório Institucional da Universidade do Estado do Amazonas (UEA) - Universidade do Estado do Amazonas (UEA)
repository.mail.fl_str_mv bibliotecacentral@uea.edu.br
_version_ 1844156631634411520