The Unusual Pathobiology of Hemoglobin Constant Spring Red Blood Cells

Abstract

Hemoglobin Constant Spring (HbCS) is the most common nondeletional α-thalassemic mutation and is an important cause of HbH-like disease in Southeast Asia. HbCS variants have an almost normal mean cell volume (MCV) and the anemia is more severe when compared with other α-thalassemic variants. We explored the pathobiology of HbCS red blood cells (RBCs) because the underlying cause(s) of this MCV “normalizing” effect of HbCS and the more severe anemia are not fully explained. HbCS containing RBCs are distinctly overhydrated relative to deletional α-thalassemia variants, and the derangement of volume regulation and cell hydration occurs early in erythroid maturation and is fully expressed at the reticulocyte stage. Furthermore, the membrane rigidity and membrane mechanical stability of HbCS containing RBCs is increased when compared with HbH and α-thalassemia-1 trait RBCs. In seeking the cause(s) underlying these cellular alterations we analyzed membranes from HbCS and deletional α-thalassemic variants and found that in addition to oxidized β-globin chains, oxidized αcs-globin chains are also associated with the membranes and their skeletons in HbCS containing RBCs. We propose that the membrane pathology of HbCS variants is caused by combination of the deleterious effects induced by membrane-bound oxidized αcs- and β-globin chains. The membrane alterations induced by αcs chains are more akin to those induced by βA-globin chains than those induced by the αA-globin chains that accumulate in the β-thalassemias. Thus, each globin chain, αcs, αA, βA, appears to produce its own form of membrane perturbation.