Concordant fetal hemoglobin response to hydroxyurea in siblings with sickle cell disease

Martin H. Steinberg, Ersi Voskaridou, Abdullah Kutlar, Dimitris Loukopoulos, Mabel Koshy, Samir K. Ballas, Oswaldo Castro, Franca Barton

Research output: Contribution to journalArticlepeer-review

30 Scopus citations


Fetal hemoglobin (HbF) level and the HbF responses to hydroxyurea (HU) vary among patients with sickle cell disease and are, at least in part, genetically regulated. We hypothesized that siblings with sickle cell disease are likely to share the same parental β-like globin gene clusters with their cis-acting regulatory sequences and therefore, if regulation of this response is linked to the β-globin gene cluster, might have concordant HbF responses to HU. Accordingly, we studied 26 families (30 sib pairings), 20 with sickle cell anemia (three families had three siblings) and 6 families with HbS-β-thalassemia (one family had three siblings, and one family consisted of monozygotic twins), to see if siblings with sickle cell disease had discordant or concordant changes in HbF during HU treatment. Intraclass correlation coefficients (r) showed a high, positive correlation between sibs for HbF levels before and during HU treatment and a concordant change in HbF response from baseline to treatment-associated levels. Changes in mean corpuscular volume (MCV) paralleled HbF levels, while the expected correlations between treatment-associated fall in leukocyte count and increase in MCV were also present. Our results provide additional evidence that some elements that regulate HbF expression are linked to the β-globin gene cluster.

Original languageEnglish (US)
Pages (from-to)121-126
Number of pages6
JournalAmerican Journal of Hematology
Issue number2
StatePublished - Feb 1 2003


  • Globin gene expression
  • β-thalassemia
  • γ-globin gene

ASJC Scopus subject areas

  • Hematology


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