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Detection of insertion and/or deletion (indel) mutations in CALR exon 9, the gene that encodes the endoplasmic reticulum-associated, calcium binding protein calreticulin, is now considered a major criterion for the diagnosis of the myeloproliferative neoplasms (MPN) essential thrombocythaemia (ET) and primary myelofibrosis. MPN-associated CALR indel mutations all result in a +1 frame shift of the coding sequence, leading to an altered amino acid composition of the translated protein and loss of the endoplasmic reticulum retention motif. The two most common CALR mutations are a 52 bp deletion and a 5 bp insertion that account for >85% of indels; however, many others of varying size have been described at a much lower frequency.1 2 A number of screening methodologies can be employed to detect CALR mutations including Sanger sequencing, fluorescent PCR followed with fragment length analysis (FLA) by capillary electrophoresis, high-resolution melt curve analysis, next-generation sequencing and quantitative PCR: each approach having its own limits of …
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