Valeria Maria Pinto

HbSC disease is the second most common type of sickle cell disease (SCD) in populations of African origin. Although it is often grouped together with other types of SCD, particularly sickle cell anemia (HbSS), it has unique pathophysiology and a different spectrum of laboratory and clinical features. Compared to HbSS, hemoglobin levels are higher, HbF is lower at less than 5%, and most vaso‐occlusive and vasculopathic complications are less frequent, although retinopathy is more common. Despite these differences, there have been no specific guidelines on the management of HbSC disease. This clinical practice guideline was developed by the European Hematology Association (EHA) in accordance with the EHA Guidelines Methodology Framework to provide consensus‐based guidance for the management of children and adults with HbSC disease. A multidisciplinary Guideline Panel was convened by the EHA Guidelines Committee and included hematologists, pediatricians, methodologists, and patient representatives with expertise in SCD and its complications. Panel members were assigned to thematic working groups based on their clinical expertise, and each group was responsible for drafting content and recommendations within their respective domains. Literature searches were conducted using PubMed for relevant studies published in English. A modified Delphi process was used to reach consensus on recommendations, and panel members voted anonymously using an online system. A predefined threshold of ≥70% agreement and <15% disagreement was required for adoption. Statements not reaching consensus were revised and subjected to further rounds of discussion and voting. Thirty‐five recommendations were adopted, including guidance on the use of hydroxyurea and therapeutic venesection.

Interpreting genetic variants in complex genes such as PIEZO1 remains challenging because of marked allelic heterogeneity, relative tolerance to missense variation, and overlapping clinical phenotypes. Gain-of-function variants in PIEZO1 cause dehydrated hereditary stomatocytosis (DHS1, or hereditary xerocytosis), a pleiotropic syndrome characterized by anemia of variable severity and iron overload. In this study, we provided and applied an integrative framework combining the American College of Medical Genetics and Genomics guidelines, quantitative in silico predictions, structural domain annotation, and detailed patient phenotyping to classify 2565 PIEZO1 variants. A Bayesian scoring system with weighted evidence and a composite predictive score enabled reclassification of nearly 1000 variants of uncertain significance and highlighted nonrandom clustering of pathogenic variants within functionally constrained domains, particularly the anchor, inner helix, and C-terminal domains. Genotype-phenotype correlation analysis in 176 in-house DHS cases identified 3 phenotypic clusters, ranging from classical DHS1 with severe hemolysis and iron overload to atypical or subclinical presentations, reflecting domain-specific pathogenic mechanisms. Overall, this reclassification of PIEZO1 variants, integrated with genotype-phenotype correlation analysis, improves diagnostic precision, supports genotype-guided patient management, and underscores the value of integrating structural and clinical data into interpretation of rare genetic variants.

Background: Hereditary hemoglobin disorders are the most common globally distributed monogenic red cell diseases. The rights of women with thalassemia or sickle cell disease (SCD) to motherhood need to be protected by creating a roadmap to guide her, and her family network, along all the phases of the event. In fact, pregnancy in these vulnerable patients requires special attention and guidelines from the counseling stage (giving information about the special requirement and risks posed by their pregnancy with respect to the general population) the pre-conception stage, the early and mid-late pregnancy stage, to labor and lactation. The biocomplexity of these diseases requires a multidisciplinary team synergizing with gynecologists and obstetricians. In addition, the presence of a multicultural scenario requires healthcare workers to overcome stereotypes and adopt appropriate anthropological tools that might help them integrate the different cultural models of disease and motherhood. Methods: The Management Committee of the Society for Thalassemia and Hemoglobinopathies (SITE) selected and brought together a multidisciplinary and multiprofessional group made up of experts in hemoglobinopathies and experts in anthropology, flanked along with by experts with methodological and organizational expertise in order to create recommendations based on the integration of available scientific evidence together with expert opinion. Results: The panelists critically analyzed the literature, combining in a single document practices developed over several years of managing young women with hemoglobinopathies in a sensitive phase of their lives. Conclusions: This good practice document is the result of a collegial effort by Italian experts on hemoglobinopathies who are members of SITE. (SITE).

In this last decade, a deeper understanding of the pathophysiology of hereditary red cell disorders and the development of novel classes of pharmacologic agents have provided novel therapeutic approaches to thalassemias, sickle cell disease (SCD), and other red cell disorders. Here, we analyze and discuss the novel therapeutic options according to their targets, taking into consideration the complex process of erythroid differentiation, maturation, and survival of erythrocytes in the peripheral circulation. We focus on active clinical exploratory and confirmatory trials on thalassemias, SCD, and other red cell disorders. Beside β-thalassemia and SCD, we found that the development of new therapeutic strategies has allowed for the design of clinic studies for hereditary red cell disorders still lacking valuable therapeutic alternative such as α-thalassemias, congenital dyserythropoietic anemia, or Diamond-Blackfan anemia. In addition, reduction of heme synthesis, which can be achieved by the repurposed antipsychotic drug bitopertin, might affect not only hematological disorders but multiorgan diseases such as erythropoietic protoporphyria. Finally, our review highlights the current state of therapeutic scenarios, in which multiple indications targeting different red cell disorders are being considered for a single agent. This is a welcome change that will hopefully expand therapeutic option for patients affected by thalassemias, SCD, and other red cell disorders.

Beta-thalassemia patient treated with thalidomide: dimensional reduction of EMH foci (MRI evaluation) and reduction of hematological responce at follow-up.image

The number of individuals with the sickle cell trait exceeds 300 million worldwide, making sickle cell disease one of the most common monogenetic diseases globally. Because of the high frequency of sickle cell disease, reproductive counseling is of crucial importance. In addition, unlike other carrier states, Sickle Cell Trait (SCT) seems to be a risk factor for several clinical complications, such as extreme exertional injury, chronic kidney disease, and complications during pregnancy and surgery. This expert panel believes that increasing knowledge about these clinical manifestations and their prevention and management can be a useful tool for all healthcare providers involved in this issue.

Luspatercept has recently been approved for the treatment of beta-thalassemia and its use in clinical practice has been increasing. As it is the first erythroid maturation drug available for this diagnosis, the expertise about its use is still limited. To address this point, and to promote awareness and guide the clinical use of luspatercept in beta-thalassemia, this paper was developed as a consensus by experts from the Italian Society of Thalassemia and Hemoglobinopathies (SITE). After a brief presentation of the core features of luspatercept, a comprehensive set of questions is addressed, covering relevant aspects for the practical management of this new therapeutic option.

Workflow of the study with some examples of the achieved results.