Spectrum of β-Globin Variants in Eastern Sudan: A Capillary Electrophoresis Study
DOI:
https://doi.org/10.21276/apalm.3878Keywords:
hemoglobin variant, β-globin, Red Sea State, SudanAbstract
Background: Hemoglobinopathies constitute a significant genetic health challenge in Sudan, with more than 20 confirmed β-globin gene variants reported across the country. Nevertheless, despite this diversity, data from eastern regions remain poorly characterized. Objective: To characterize β-globin variants among patients investigated for hemoglobin disorders in Red Sea State, Sudan.
Methodology: This hospital-based study was performed from December 2013 to December 2015. Among 600 patients screened for anemia, 55 patients with microcytic hypochromic anemia unrelated to iron deficiency were included. Hemoglobin fractions were analyzed using capillary electrophoresis and confirmed by molecular testing in selected cases. Hematologic parameters and hemoglobin fractions were statistically analyzed using SPSS.
Results: The β-thalassemia trait was the most frequent diagnosis (52.7%). Sickle cell syndromes were also prevalent, including sickle cell trait (18.2%), sickle cell disease (14.5%), and HbS-β-thalassemia (12.7%). Critically, HbA₂ reveals a strong diagnostic screening marker for β-thalassemia (AUC = 0.803), with a cutoff of 3.45%. Elevated HbF levels were associated with severe phenotypes, reaching 10.0 ± 5.6% in sickle cell disease and 49.9% in β-thalassemia major.
Conclusion: β-thalassemia and sickle cell disorders reveal a substantial clinical burden in eastern Sudan. HbA₂ has notable diagnostic utility for β-thalassemia trait, whereas HbF correlates with disease severity. These findings provide preliminary evidence that may inform future population-based screening strategies to improve clinical care.
References
1. Bain BJ. Haemoglobinopathy diagnosis. 3rd ed. Hoboken: Wiley-Blackwell; 2020.
2. Modell B, Darlison M. Global epidemiology of haemoglobin disorders and derived service indicators. Bull World Health Organ. 2008 Jun;86(6):480-7.
3. Higgs DR, Engel JD, Stamatoyannopoulos G. Thalassaemia. Lancet. 2012 Jan 28;379(9813):373-83.
4. Piel FB, Steinberg MH, Rees DC. Sickle cell disease. N Engl J Med. 2017 Apr 20;376(16):1561-73.
5. Harteveld CL, Higgs DR. Alpha-thalassaemia. Orphanet J Rare Dis. 2010 Feb 12;5:13.
6. Sabahelzain MM, Hamamy H. The ethnic distribution of sickle cell disease in Sudan. Pan Afr Med J. 2014 May 3;18:13.
7. Kattamis C, Forni GL, Aydinok Y, Viprakasit V. Changing patterns in the epidemiology of β-thalassemia. Eur J Haematol. 2020 Jul;105(6):692-703.
8. Bain BJ, Daniel Y, Henthorn J, de la Salle B, Hogan A, Roy NBA, et al.; BSH Committee. Significant haemoglobinopathies: A guideline for screening and diagnosis. Br J Haematol. 2023 Jun;201(6):1047-65.
9. Farmakis D, Porter J, Taher A, Cappellini MD, Angastiniotis M, Eleftheriou A. 2021 Thalassaemia International Federation Guidelines for the Management of Transfusion-dependent Thalassemia. Hemasphere. 2022 Jul 29;6(8):e732.
10. Adam MA, Adam NK, Mohamed BA. Prevalence of sickle cell disease and sickle cell trait among children admitted to Al Fashir Teaching Hospital North Darfur State, Sudan. BMC Res Notes. 2019 Oct 16;12(1):659.
11. Elderdery AY, Mills J, Mohamed BA, Cooper AJ, Mohammed AO, Eltieb N, et al. Molecular analysis of the β-globin gene cluster haplotypes in a Sudanese population with sickle cell anaemia. Int J Lab Hematol. 2012 Jun;34(3):262-6.
12. Elshaikh RH, Babikir HEH, Babker AMA, Shaya ASB, Alfahed A, Alharthi NS, et al. Molecular aspects of the common types of β-thalassemia mutations among Sudanese patients: a cross-sectional study. Eur Rev Med Pharmacol Sci. 2023 May;27(10):4520-7.
13. Çakır Madenci Ö, Hürmeydan Ö, Orçun A, Erdoğmuş F. Comparison of Capillary Zone Electrophoresis with High-pressure Liquid Chromatography in the Evaluation of Hemoglobinopathies. Turk J Haematol. 2023 Dec 5;40(4):258-65.
14. GBD 2021 Hemoglobinopathies and Hemolytic Anemias Collaborators. Burden of hemoglobinopathies and hemolytic anemias in the World Health Organization African region, 2000-2021: Findings from the Global Burden of Disease 2021 study. PLOS Glob Public Health. 2025 Sep 22;5(9):e0005197.
15. Gibreel MO, Mohammed BAB. Hemoglobin F and the Clinical Trajectory among Eastern Sudanese Patients with Sickle Cell Anemia. Middle East Res J Case Rep. 2022;2(1):1-4.
16. Khan AM, Al-Sulaiti AM, Younes S, Yassin M, Zayed H. The spectrum of beta-thalassemia mutations in the 22 Arab countries: a systematic review. Expert Rev Hematol. 2021 Jan;14(1):109-22.
17. Steinberg MH. Fetal hemoglobin in sickle cell anemia. Blood. 2020 Nov 19;136(21):2392-400.
18. Kirkham JK, Estepp JH, Weiss MJ, Rashkin SR. Genetic Variation and Sickle Cell Disease Severity: A Systematic Review and Meta-Analysis. JAMA Netw Open. 2023 Oct 2;6(10):e2337484.
19. Mentan CL, Tante EA, Ngo Um SS, Emore ME, Nansseu JR. Hemoglobin variants and sickle cell trait in Central and West Africa: a systematic review and meta-analysis. Hemoglobin. 2023 Jan;47(1):1-11.
20. Gibreel MO, Bashir BA. Red cell distribution width as a proxy marker of hemoglobinopathies among an eastern Sudan patient population. J Clin Med Images Case Rep. 2022;2(5):1247.
21. Thilakarathne S, Jayaweera UP, Premawardhena A. Unresolved laboratory issues of the heterozygous state of β-thalassemia: a literature review. Haematologica. 2024 Jan 1;109(1):23-32.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Mohamed Omer Gibreel, Bashir Abdrhman Bashir

This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access at http://opcit.eprints.org/oacitation-biblio.html).

