Alpha thalassemia genotypes in Kuwait

BACKGROUND: The frequency of the alpha thalassemia trait is approximately 40% in the Kuwaiti population, but there has been no comprehensive study of the prevalent alleles. This is a report of patients who were referred for molecular diagnosis over a 20-year period. METHODS: This is a retrospective study of the α-globin genotypes obtained in the Hemoglobin Research Laboratory of the Department of Pediatrics, Kuwait University from 1994 to 2015. Genotyping was performed by a combination of PCR, allele-specific oligonucleotide hybridization and reverse dot blot hybridization (Vienna Lab Strip Assay). RESULTS: Four hundred samples were characterized and analyzed from individuals aged < 1 month to 80 years, with a median of 6 years from 283 unrelated families. Most (90.8%) were Kuwaiti nationals. The commonest genotype was homozygosity for the polyadenylation-1 mutation (α(PA-1)α/α (PA-1)α) in 33.3% of the samples, followed by heterozygosity (αα/α (PA-1)α) for the same mutation in 32.3%. PA-1 was therefore the most frequent allele (0.59). The frequency of the α(0) (−-(MED)) allele was 0.017. Rare alleles that were found in very low frequencies included α(0) (−-(FIL)) in a Filipino child, Hb Constant Spring, Hb Adana, and Hb Icaria. CONCLUSION: There is a wide variety of alpha thalassemia alleles among Kuwaitis, but nondeletional PA-1 is by far the most common cause of the moderate to severe HbH (β4 tetramer) disease phenotype. The α(0) (−(MED)) allele is also encountered, which has implications for premarital counseling, especially for the possibility of having babies with alpha thalassemia major (Barts hydrops fetalis).