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Pathogenesis of Hemolytic Anemia in Homozygous Hemoglobin C Disease*

Samuel Charache, C. Lockard Conley, David F. Waugh, Richard J. Ugoretz and J. Richard Spurrell

Department of Medicine, The Johns Hopkins University and Hospital, Baltimore, MarylandDepartment of Biology, Massachusetts Institute of Technology, Boston, Massachusetts

Henry Strong Denison Scholar for 1966-67.

* Received for publication 19 May 1967 and in revised form 12 July 1967.

Published November 1967

Hemoglobin C is less soluble than hemoglobin A in red cells, in hemolysates, and in dilute phosphate buffer. Its relative insolubility may be explained by electrostatic interactions between positively charged β6-lysyl groups and negatively charged groups on adjacent molecules. Red cells from patients with homozygous hemoglobin C (CC) disease exhibit aberrant physical properties which suggest that the cells are more rigid than normal erythrocytes. They pass through membrane filters less readily than normal red cells do, and their viscosity is higher than that of normal cells. Differences from normal cells are exaggerated if mean corpuscular hemoglobin concentration (MCHC) is increased, by suspension in hypertonic salt solution. Increased rigidity of CC cells, by accelerating their fragmentation, may be responsible for formation of microspherocytes. These small dense cells are exceptionally rigid, and probably are even more susceptible to fragmentation and sequestration. Rigidity of CC cells can be attributed to a “precrystalline” state of intracellular hemoglobin, in which crystallization does not occur, although the MCHC exceeds the solubility of hemoglobin in hemolysates.

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