Hemoglobin Old Dominion/Burton-upon-Trent, β143 (H21) His→Tyr, Codon 143 CAC→TAC - A Variant with Altered Oxygen Affinity that Compromises Measurement of Glycated Hemoglobin in Diabetes Mellitus: Structure, Function, and DNA Sequence

Objective: To determine the nature and characteristics of a unique hemoglobin variant that causes a spurious increase in glycated hemoglobin (Hb A_1c). Material and Methods: Blood specimens from four unrelated persons with this hemoglobin variant were examined by conventional laboratory methods, including electrophoresis, high-performance ion-exchange chromatography, and isoelectric focusing; by amino acid sequence analysis, polymerase chain reaction-based DNA sequence analysis, and electrospray ionization mass spectrometry, to establish the molecular structure; and by studies of oxygen affinity under varied conditions, to define the functional characteristics of the hemoglobin variant. Results: The unique hemoglobin variant observed in these four cases is due to the mutation CAC→TAC, at β-globin gene codon 143, corresponding to β143 (H21) His→Tyr. This amino acid substitution affects an important 2,3-diphosphoglycerate binding site and slightly increases the oxygen affinity of the hemoglobin variant. Conclusion: A hitherto unrecognized hemoglobin variant, encountered in four unrelated persons of Irish or Scots-Irish ancestry, hemoglobin Old Dominion/Burtonupon-Trent, β143 (H21) His→Tyr, has now been characterized at the molecular, structural, and functional levels. Although it is associated with a slight increase in oxygen affinity, it is without hematologic effect, and its only clinical significance is that it coelutes with Hb A_1c on ion-exchange chromatography and thereby causes a spurious increase in Hb A_1c and compromises the use of this analyte to monitor the treatment of diabetes mellitus.