Diagnosis

Identification of alpha-thalassemia carriers is difficult because they do not have typical changes in HbA2 or HbF.

Carriers with — alpha/alpha/alpha and--/alpha alpha genotypes have always reduced MCV and MCH, while — alpha/ alpha alpha carriers may have normal red cell indices or only slightly reduced MCV and MCH. The hemoglobin pattern is normal.

Reliable diagnosis of the alpha-thalassemia carrier states can only be achieved by DNA analysis with PCR-based methods or globin chain synthesis analysis that shows an alpha/beta ratio lower than 0.9 (see below ''Molecular Diagnosis of Alpha-Thalassemia'').[61 Identification of alpha°-thalassamia carriers is important for the prevention of Hb Bart's hydrops fetalis syndrome. In the newborn the electrophoretic detection of the fast moving band of Hb Bart's is an indication of the presence of alpha-thalassemia. However, in some carriers Hb Bart's may be not detected.

HbH is easily detected as a fast-moving band by cellulose acetate electrophoresis. Another simple and very sensitive test consists in the detection of inclusion bodies in the red blood cells which can be generated by incubating peripheral blood with supravital stains.[61 Determination of alpha globin genotype by molecular methods is useful for prognosis of HbH disease, as the nondeletion forms are more severe than the deletion forms.[31 In the neonatal period subjects with HbH disease genotype can be detected by hemoglobin electrophoresis because they have elevated levels ( — 25%) of Hb Bart's. Hb Bart's hydrops fetalis syndrome can be prenatally identified by DNA analysis, fetal blood analysis, or using ultrasound (cardiothoracic ratio greater than 0.05).[6,71

Getting Started With Dumbbells

Getting Started With Dumbbells

The use of dumbbells gives you a much more comprehensive strengthening effect because the workout engages your stabilizer muscles, in addition to the muscle you may be pin-pointing. Without all of the belts and artificial stabilizers of a machine, you also engage your core muscles, which are your body's natural stabilizers.

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