{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T14:53:46Z","timestamp":1786632826622,"version":"build-2736575974"},"reference-count":45,"publisher":"Wiley","issue":"15","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100004071","name":"Khon Kaen University","doi-asserted-by":"publisher","award":["FF2569 KKU"],"award-info":[{"award-number":["FF2569 KKU"]}],"id":[{"id":"10.13039\/501100004071","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010724","name":"Health Systems Research Institute","doi-asserted-by":"publisher","award":["HSRI 68\u2010049"],"award-info":[{"award-number":["HSRI 68\u2010049"]}],"id":[{"id":"10.13039\/501100010724","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Laboratory Analysis"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      In Thailand, the Hb A\n                      <jats:sub>2<\/jats:sub>\n                      cut\u2010off value for \u03b2\u2010thalassemia carrier has been changed from 4.0% to 3.6% since 2015. We examined the molecular basis of \u03b2\u2010thalassemia in a large cohort of Thai subjects with this change.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A total of 36,313 retrospective specimens encountered during January 2016 to June 2025 were reviewed, and 5909 subjects (16.7%) with Hb A\n                      <jats:sub>2<\/jats:sub>\n                      \u2009\u2265\u20093.6% were recruited. Diagnosis of thalassemia was based on Hb and DNA analyses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among the 5909 subjects, 5395 (91.3%) had Hb A\n                      <jats:sub>2<\/jats:sub>\n                      A, 115 (1.9%) carried Hb variants, and the remaining 399 (6.8%) resulted from misinterpretations. Of 5395 subjects, 5117 (94.8%) carried \u03b2\u2010thalassemia, 189 (3.5%) had normal \u03b2\u2010globin genes, and 89 (1.6%) had incomplete molecular analysis. Fifty different \u03b2\u2010thalassemia genes were identified, including nine hitherto undescribed in Thailand and two novel mutations, \u03b2\n                      <jats:sup>CD81(CTC &gt; CTA)<\/jats:sup>\n                      and \u03b2\n                      <jats:sup>IVSII\u2010713(G &gt; A)<\/jats:sup>\n                      . Falsely elevated Hb A\n                      <jats:sub>2<\/jats:sub>\n                      was found in 364 of 399 (70.8%) subjects with misinterpretation, 20 (3.9%) represented human errors, and 15 (2.9%) resulted from Hb E blood transfusion. A low proportion of \u03b2\n                      <jats:sup>0<\/jats:sup>\n                      \u2010 and a high proportion of \u03b2\n                      <jats:sup>+<\/jats:sup>\n                      \u2010thalassemias, a normal \u03b2\u2010globin gene, and diagnostic errors were observed at borderline Hb A\n                      <jats:sub>2<\/jats:sub>\n                      levels.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      A change in the Hb A\n                      <jats:sub>2<\/jats:sub>\n                      cut\u2010off can alter the molecular spectrum of \u03b2\u2010thalassemia in Thailand. The molecular basis of \u03b2\u2010thalassemia was updated to include 50 mutations, both new and known. Misinterpretation at borderline Hb A\n                      <jats:sub>2<\/jats:sub>\n                      should be aware and cost\u2010effectiveness should be considered at the screening of \u03b2\u2010thalassemia in the region.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jcla.70294","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T05:51:43Z","timestamp":1782453103000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Elevated Hemoglobin\n                    <scp>\n                      A\n                      <sub>2<\/sub>\n                    <\/scp>\n                    : A Molecular Revisited, and Implications to \u03b2\u2010Thalassemia Screening"],"prefix":"10.1002","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8716-5745","authenticated-orcid":false,"given":"Kritsada","family":"Singha","sequence":"first","affiliation":[{"name":"Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences Khon Kaen University  Khon Kaen Thailand"},{"name":"Biomedical Science Research Unit, Faculty of Medicine Mahasarakham University  Mueang Maha Sarakham Mahasarakham Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anupong","family":"Pansuwan","sequence":"additional","affiliation":[{"name":"Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences Khon Kaen University  Khon Kaen Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hataichanok","family":"Srivorakun","sequence":"additional","affiliation":[{"name":"Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences Khon Kaen University  Khon Kaen Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Attawut","family":"Chaibunruang","sequence":"additional","affiliation":[{"name":"Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences Khon Kaen University  Khon Kaen Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Supawadee","family":"Yamsri","sequence":"additional","affiliation":[{"name":"Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences Khon Kaen University  Khon Kaen Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanicha","family":"Tepakhan","sequence":"additional","affiliation":[{"name":"Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences Khon Kaen University  Khon Kaen Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanokwan","family":"Sanchaisuriya","sequence":"additional","affiliation":[{"name":"Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences Khon Kaen University  Khon Kaen Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Goonnapa","family":"Fucharoen","sequence":"additional","affiliation":[{"name":"Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences Khon Kaen University  Khon Kaen Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9142-5079","authenticated-orcid":false,"given":"Supan","family":"Fucharoen","sequence":"additional","affiliation":[{"name":"Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences Khon Kaen University  Khon Kaen Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,25]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.2514"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hoc.2015.12.001"},{"key":"e_1_2_11_4_1","first-page":"364","article-title":"A Simplified Screening Strategy for Thalassaemia and Haemoglobin E in Rural Communities in South\u2010East Asia","volume":"82","author":"Fucharoen G.","year":"2004","journal-title":"Bulletin of the World Health Organization"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/jcp.2008.056945"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1751\u2010553X.2011.01368.x"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2022.282667"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.5114\/aoms.2020.93392"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bcmd.2018.10.002"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bcmd.2011.05.003"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12185\u2010019\u201002761\u20104"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1515\/cclm\u20102013\u20100098"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/03630269.2021.1924193"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0108365"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bcmd.2009.12.011"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40246\u2010023\u201000451\u20101"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajhg.2022.10.013"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gim.2025.101402"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1089\/cmb.1997.4.311"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/gb\u20102006\u20107\u2010s1\u2010s10"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1258\/acb.2009.009222"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bcmd.2011.09.008"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/jclinpath\u20102014\u2010202825"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms25168928"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2020005934"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0103020"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1080\/10245332.2016.1231989"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.3109\/03630268609036570"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bcmd.2004.12.006"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1080\/03630269.2021.1908347"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0346729"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.trsl.2011.10.008"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cca.2023.117615"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijlh.13511"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.7717\/peerj.15308"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijlh.13900"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1177\/1753495X231207676"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijlh.12585"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1515\/cclm\u20102023\u20101006"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0283051"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bcmd.2014.11.008"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hoc.2017.11.006"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1080\/07853890.2025.2551815"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.7754\/clin.lab.2015.150720"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471\u20100528.15045"},{"key":"e_1_2_11_46_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood\u20102010\u201001\u2010251348"}],"container-title":["Journal of Clinical Laboratory Analysis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jcla.70294","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jcla.70294","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jcla.70294","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T14:23:02Z","timestamp":1786630982000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jcla.70294"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,25]]},"references-count":45,"journal-issue":{"issue":"15","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1002\/jcla.70294"],"URL":"https:\/\/doi.org\/10.1002\/jcla.70294","archive":["Portico"],"relation":{},"ISSN":["0887-8013","1098-2825"],"issn-type":[{"value":"0887-8013","type":"print"},{"value":"1098-2825","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,25]]},"assertion":[{"value":"2026-03-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-10","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70294"}}