1
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Chonat S, Eber SW, Holzhauer S, Kollmar N, Morton DH, Glader B, Neufeld EJ, Yaish HM, Rothman JA, Sharma M, Ravindranath Y, Wang H, Breakey VR, Sheth S, Bradeen HA, Al-Sayegh H, London WB, Grace RF. Pyruvate kinase deficiency in children. Pediatr Blood Cancer 2021; 68:e29148. [PMID: 34125488 DOI: 10.1002/pbc.29148] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/08/2021] [Accepted: 05/13/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Pyruvate kinase deficiency (PKD) is a rare, autosomal recessive red blood cell enzyme disorder, which leads to lifelong hemolytic anemia and associated complications from the disease and its management. METHODS An international, multicenter registry enrolled 124 individuals younger than 18 years old with molecularly confirmed PKD from 29 centers. Retrospective and prospective clinical data were collected. RESULTS There was a wide range in the age at diagnosis from 0 to 16 years. Presentation in the newborn period ranged from asymptomatic to neonatal jaundice to fulminant presentations of fetal distress, myocardial depression, and/or liver failure. Children <5 years old were significantly more likely to be transfused than children >12 to <18 years (53% vs. 14%, p = .0006), which correlated with the timing of splenectomy. Regular transfusions were most common in children with two severe PKLR variants. In regularly transfused children, the nadir hemoglobin goal varied considerably. Impact on quality of life was a common reason for treatment with regular blood transfusions and splenectomy. Splenectomy increased the hemoglobin and decreased transfusion burden in most children but was associated with infection or sepsis (12%) and thrombosis (1.3%) even during childhood. Complication rates were high, including iron overload (48%), perinatal complications (31%), and gallstones (20%). CONCLUSIONS There is a high burden of disease in children with PKD, with wide practice variation in monitoring and treatment. Clinicians must recognize the spectrum of the manifestations of PKD for early diagnostic testing, close monitoring, and management to avoid serious complications in childhood.
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Affiliation(s)
- Satheesh Chonat
- Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Stefan W Eber
- Schwerpunktpraxis für Pädiatrische Hämatologie-Onkologie, Munich, Germany
| | - Susanne Holzhauer
- Charité, University Medicine, Pediatric Hematology and Oncology, Berlin, Germany
| | | | - D Holmes Morton
- Central Pennsylvania Clinic for Special Children & Adults, Belleville, Pennsylvania, USA.,Lancaster General Hospital, Lancaster, Pennsylvania, USA
| | - Bertil Glader
- Lucile Packard Children's Hospital, Stanford University, Palo Alto, California, USA
| | - Ellis J Neufeld
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Hassan M Yaish
- Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA
| | | | - Mukta Sharma
- Children's Mercy, School of Medicine University of Missouri, Kansas City, Missouri, USA
| | - Yaddanapudi Ravindranath
- Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Heng Wang
- DDC Clinic for Special Needs Children, Middlefield, Ohio, USA
| | | | - Sujit Sheth
- Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA
| | - Heather A Bradeen
- The University of Vermont Children's Hospital, Burlington, Vermont, USA
| | - Hasan Al-Sayegh
- Dana-Farber/Boston Children's Cancer and Blood Disorder Center, Boston, Massachusetts, USA
| | - Wendy B London
- Dana-Farber/Boston Children's Cancer and Blood Disorder Center, Boston, Massachusetts, USA
| | - Rachael F Grace
- Dana-Farber/Boston Children's Cancer and Blood Disorder Center, Boston, Massachusetts, USA
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2
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Boscoe AN, Yan Y, Hedgeman E, van Beers EJ, Al-Samkari H, Barcellini W, Eber SW, Glader B, Yaish HM, Chonat S, Sharma M, Kuo KHM, Neufeld EJ, Wang H, Verhovsek M, Sheth S, Grace RF. Comorbidities and complications in adults with pyruvate kinase deficiency. Eur J Haematol 2021; 106:484-492. [PMID: 33370479 PMCID: PMC7985869 DOI: 10.1111/ejh.13572] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 01/19/2023]
Abstract
Objectives Pyruvate kinase (PK) deficiency is caused by PKLR gene mutations, leading to defective red blood cell glycolysis and hemolytic anemia. Rates of comorbidities and complications by transfusion history and relative to the general population remain poorly quantified. Methods Data for patients aged ≥ 18 years with two confirmed PKLR mutations were obtained from the PK deficiency Natural History Study (NCT02053480). Frequencies of select conditions were compared with an age‐ and sex‐matched cohort from a general insured US population without PK deficiency. Results Compared with the matched population (n = 1220), patients with PK deficiency (n = 122) had significantly higher lifetime rates of osteoporosis, liver cirrhosis, and pulmonary hypertension; splenectomy and cholecystectomy rates were also significantly higher in the 8 years before the index date. Sixty‐five (53.3%) patients with PK deficiency were classified as regularly transfused, 30 (24.6%) as occasionally transfused, and 27 (22.1%) as never transfused. Regularly transfused patients were significantly more likely than never transfused patients to have had splenectomy, cholecystectomy, and/or thrombosis. Liver iron overload was reported in 62% of patients and occurred regardless of transfusion cohort. Conclusions Even never transfused patients with PK deficiency had higher rates of select comorbidities and complications than individuals without PK deficiency.
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Affiliation(s)
| | - Yan Yan
- Agios Pharmaceuticals, Inc., Cambridge, MA, USA
| | | | - Eduard J van Beers
- Van Creveldkliniek, University Medical Center Utrecht, University of Utrecht, The Netherlands
| | - Hanny Al-Samkari
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Wilma Barcellini
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefan W Eber
- Special Praxis for Pediatric Hematology and University Children's Hospital, Technical University, Munich, Germany
| | - Bertil Glader
- Stanford University School of Medicine, Palo Alto, CA, USA
| | - Hassan M Yaish
- Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA
| | - Satheesh Chonat
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, and Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Mukta Sharma
- Children's Mercy, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | | | | | - Heng Wang
- DDC Clinic for Special Needs Children, Middlefield, OH, USA
| | | | - Sujit Sheth
- Weill Cornell Medical College, New York, NY, USA
| | - Rachael F Grace
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
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3
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Al-Samkari H, van Beers EJ, Morton DH, Barcellini W, Eber SW, Glader B, Yaish HM, Chonat S, Kuo KHM, Kollmar N, Despotovic JM, Pospíšilová D, Knoll CM, Kwiatkowski JL, Pastore YD, Thompson AA, Wlodarski MW, Ravindranath Y, Rothman JA, Wang H, Holzhauer S, Breakey VR, Verhovsek MM, Kunz J, Sheth S, Sharma M, Rose MJ, Bradeen HA, McNaull MN, Addonizio K, Al-Sayegh H, London WB, Grace RF. Characterization of the severe phenotype of pyruvate kinase deficiency. Am J Hematol 2020; 95:E281-E285. [PMID: 32619047 DOI: 10.1002/ajh.25926] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 06/30/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Hanny Al-Samkari
- Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - D Holmes Morton
- Central Pennsylvania Clinic for Special Children & Adults, Belleville, Pennsylvania
- Lancaster General Hospital, Lancaster, Pennsylvania
| | - Wilma Barcellini
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefan W Eber
- Schwerpunktpraxis für Pädiatrische Hämatologie-Onkologie and Children's Hospital, Technical University, Munich, Germany
| | - Bertil Glader
- Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
| | - Hassan M Yaish
- Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Satheesh Chonat
- Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Kevin H M Kuo
- University of Toronto, University Health Network, Toronto, Ontario, Canada
| | | | - Jenny M Despotovic
- Texas Children's Hematology Center, Baylor College of Medicine, Houston, Texas
| | | | | | - Janet L Kwiatkowski
- Children's Hospital of Philadelphia and Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Alexis A Thompson
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Marcin W Wlodarski
- St. Jude Children's Research Hospital, Memphis, Tennessee
- University of Freiburg, Freiburg, Germany
| | | | | | - Heng Wang
- DDC Clinic for Special Needs Children, Middlefield, Ohio
| | | | | | | | - Joachim Kunz
- Zentrum für Kinder-und Jugendmedizin, Heidelberg, Germany
| | - Sujit Sheth
- Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - Mukta Sharma
- Children's Mercy, University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Melissa J Rose
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | | | | | - Kathryn Addonizio
- Dana-Farber Boston Children's Cancer and Blood Disorder Center, Harvard Medical School, Boston, Massachusetts
| | - Hasan Al-Sayegh
- Dana-Farber Boston Children's Cancer and Blood Disorder Center, Harvard Medical School, Boston, Massachusetts
| | - Wendy B London
- Dana-Farber Boston Children's Cancer and Blood Disorder Center, Harvard Medical School, Boston, Massachusetts
| | - Rachael F Grace
- Dana-Farber Boston Children's Cancer and Blood Disorder Center, Harvard Medical School, Boston, Massachusetts
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4
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Bianchi P, Fermo E, Lezon‐Geyda K, Beers EJ, Morton HD, Barcellini W, Glader B, Chonat S, Ravindranath Y, Newburger PE, Kollmar N, Despotovic JM, Verhovsek M, Sharma M, Kwiatkowski JL, Kuo KHM, Wlodarski MW, Yaish HM, Holzhauer S, Wang H, Kunz J, Addonizio K, Al‐Sayegh H, London WB, Andres O, Wijk R, Gallagher PG, Grace RFF. Genotype-phenotype correlation and molecular heterogeneity in pyruvate kinase deficiency. Am J Hematol 2020; 95:472-482. [PMID: 32043619 DOI: 10.1002/ajh.25753] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 01/15/2020] [Accepted: 01/21/2020] [Indexed: 01/19/2023]
Abstract
Pyruvate kinase (PK) deficiency is a rare recessive congenital hemolytic anemia caused by mutations in the PKLR gene. This study reports the molecular features of 257 patients enrolled in the PKD Natural History Study. Of the 127 different pathogenic variants detected, 84 were missense and 43 non-missense, including 20 stop-gain, 11 affecting splicing, five large deletions, four in-frame indels, and three promoter variants. Within the 177 unrelated patients, 35 were homozygous and 142 compound heterozygous (77 for two missense, 48 for one missense and one non-missense, and 17 for two non-missense variants); the two most frequent mutations were p.R510Q in 23% and p.R486W in 9% of mutated alleles. Fifty-five (21%) patients were found to have at least one previously unreported variant with 45 newly described mutations. Patients with two non-missense mutations had lower hemoglobin levels, higher numbers of lifetime transfusions, and higher rates of complications including iron overload, extramedullary hematopoiesis, and pulmonary hypertension. Rare severe complications, including lower extremity ulcerations and hepatic failure, were seen more frequently in patients with non-missense mutations or with missense mutations characterized by severe protein instability. The PKLR genotype did not correlate with the frequency of complications in utero or in the newborn period. With ICCs ranging from 0.4 to 0.61, about the same degree of clinical similarity exists within siblings as it does between siblings, in terms of hemoglobin, total bilirubin, splenectomy status, and cholecystectomy status. Pregnancy outcomes were similar across genotypes in PK deficient women. This report confirms the wide genetic heterogeneity of PK deficiency.
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Affiliation(s)
- Paola Bianchi
- U.O.C. EmatologiaU.O.S. Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico Milan Italy
| | - Elisa Fermo
- U.O.C. EmatologiaU.O.S. Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico Milan Italy
| | | | - Eduard J. Beers
- Division Internal Medicine and DermatologyVan Creveldkliniek, University Medical Center Utrecht Utrecht The Netherlands
| | - Holmes D. Morton
- Central Pennsylvania Clinic for Special Children & AdultsBelleville, PA; Lancaster General Hospital Lancaster PA
| | - Wilma Barcellini
- U.O.C. EmatologiaU.O.S. Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico Milan Italy
| | - Bertil Glader
- Lucile Packard Children's HospitalStanford University Palo Alto CA
| | - Satheesh Chonat
- Department of PediatricsEmory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta Atlanta GA
| | - Yaddanapudi Ravindranath
- School of MedicinePediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine Detroit MI
| | - Peter E. Newburger
- Department of PediatricsUniversity of Massachusetts Medical School Worcester MA
| | - Nina Kollmar
- Department of Pediatric Hematology/OncologyKlinikum Kassel GmbH Kassel Germany
| | | | | | - Mukta Sharma
- Department of PediatricsChildren's Mercy, School of Medicine University of Missouri Kansas City MO
| | - Janet L. Kwiatkowski
- Division of HematologyChildren's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania Philadelphia PA
| | - Kevin H. M. Kuo
- Division of Hematology, Department of MedicineUniversity Health Network, University of Toronto Toronto Ontario Canada
| | | | - Hassan M. Yaish
- Primary Children's HospitalUniversity of Utah Salt Lake City UT
| | - Susanne Holzhauer
- CharitéUniversity Medicine, Pediatric Hematology and Oncology Berlin Germany
| | - Heng Wang
- DDC Clinic for Special Needs Children Middlefield OH
| | - Joachim Kunz
- Zentrumfür Kinder‐und Jugendmedizin Heidelberg Germany
| | - Kathryn Addonizio
- Dana‐Farber/Boston Children's Cancer and Blood Disorder Center Boston MA
| | - Hasan Al‐Sayegh
- Dana‐Farber/Boston Children's Cancer and Blood Disorder Center Boston MA
| | - Wendy B. London
- Dana‐Farber/Boston Children's Cancer and Blood Disorder Center Boston MA
| | - Oliver Andres
- Department of PediatricsUniversity of Würzburg Würzburg Germany
| | - Richard Wijk
- Central Diagnostic LaboratoryUniversity Medical Center Utrecht Utrecht The Netherlands
| | - Patrick G. Gallagher
- Department of Pediatrics, Department of Genetics, Department of PathologyYale University School of Medicine New Haven CT
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5
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Bahr TM, Christensen RD, Ward DM, Meng F, Jackson LK, Doyle K, Christensen DR, Harvey AG, Yaish HM. Ferritin in serum and urine: A pilot study. Blood Cells Mol Dis 2019; 76:59-62. [PMID: 30777730 DOI: 10.1016/j.bcmd.2019.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 10/27/2022]
Abstract
Serum ferritin reflects total body iron stores, thus a low serum ferritin is used as a parameter of iron deficiency. In healthy adults in Japan, urine ferritin levels were about 5% of serum ferritin levels, with a correlation coefficient of 0.79. It is not known whether a low urine ferritin could serve as a non-invasive screen for iron deficiency. If so, this might be useful for neonates and young children, avoiding phlebotomy to screen for iron deficiency. However, for urinary ferritin screening to be feasible, ferritin must be measurable in the urine and correlate with serum ferritin. Testing should also clarify whether the iron content of ferritin in serum and urine are similar. In this pilot feasibility study we measured ferritin in paired serum and urine samples of healthy adult males, healthy term neonates, growing preterm neonates, and children who had very high serum ferritin levels from liver disorders or iron overload. We detected ferritin in every urine sample, and found a correlation with paired serum ferritin (Spearman correlation coefficient 0.78 of log10-transformed values). These findings suggest merit in further studying urinary ferritin in select populations, as a potential non-invasive screen to assess iron stores.
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Affiliation(s)
- Timothy M Bahr
- Division of Neonatology, University of Utah, Salt Lake City, UT, USA.
| | - Robert D Christensen
- Division of Neonatology, University of Utah, Salt Lake City, UT, USA; Center for Iron and Heme Disorders, University of Utah, Salt Lake City, UT, USA; Women and Newborn's Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA; Division of Hematology/Oncology, University of Utah, Salt Lake City, UT, USA
| | - Diane M Ward
- Center for Iron and Heme Disorders, University of Utah, Salt Lake City, UT, USA; Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Fanjing Meng
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Laurie K Jackson
- Center for Iron and Heme Disorders, University of Utah, Salt Lake City, UT, USA; Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Kelly Doyle
- Department of Pathology, University of Utah, Salt Lake City, UT, USA; Central Laboratories, Intermountain Medical Center, Murray, UT, USA
| | | | - Anne G Harvey
- Division of Hematology/Oncology, University of Utah, Salt Lake City, UT, USA
| | - Hassan M Yaish
- Division of Hematology/Oncology, University of Utah, Salt Lake City, UT, USA
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6
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van Beers EJ, van Straaten S, Morton DH, Barcellini W, Eber SW, Glader B, Yaish HM, Chonat S, Kwiatkowski JL, Rothman JA, Sharma M, Neufeld EJ, Sheth S, Despotovic JM, Kollmar N, Pospíšilová D, Knoll CM, Kuo K, Pastore YD, Thompson AA, Newburger PE, Ravindranath Y, Wang WC, Wlodarski MW, Wang H, Holzhauer S, Breakey VR, Verhovsek M, Kunz J, McNaull MA, Rose MJ, Bradeen HA, Addonizio K, Li A, Al-Sayegh H, London WB, Grace RF. Prevalence and management of iron overload in pyruvate kinase deficiency: report from the Pyruvate Kinase Deficiency Natural History Study. Haematologica 2018; 104:e51-e53. [PMID: 30213831 DOI: 10.3324/haematol.2018.196295] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Eduard J van Beers
- Van Creveldkliniek, University Medical Centre Utrecht, University of Utrecht, the Netherlands
| | - Stephanie van Straaten
- Van Creveldkliniek, University Medical Centre Utrecht, University of Utrecht, the Netherlands
| | - D Holmes Morton
- Central Pennsylvania Clinic for Special Children & Adults, Belleville, PA, USA Lancaster General Hospital, Lancaster, PA, USA
| | - Wilma Barcellini
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefan W Eber
- Schwerpunktpraxis für Pädiatrische Hämatologie-Onkologie and Children's Hospital, Technical University, Munich, Germany
| | - Bertil Glader
- Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - Hassan M Yaish
- Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA
| | - Satheesh Chonat
- Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, GA, USA
| | - Janet L Kwiatkowski
- Children's Hospital of Philadelphia and Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Mukta Sharma
- Children's Mercy Hospital, University of Missouri, Kansas City, MO, USA
| | | | - Sujit Sheth
- Weill Cornell Medical College, New York Presbyterian Hospital, NY, USA
| | - Jenny M Despotovic
- Texas Children's Hematology Center, Baylor College of Medicine, Houston, TX, USA
| | | | | | | | - Kevin Kuo
- University of Toronto, University Health Network, ON, Canada
| | | | - Alexis A Thompson
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | | | | | | | - Marcin W Wlodarski
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Germany
| | - Heng Wang
- DDC Clinic for Special Needs Children, Middlefield, OH, USA
| | | | | | | | - Joachim Kunz
- Zentrum für Kinder-und Jugendmedizin,University of Heidelberg, Heidelberg, Germany
| | | | - Melissa J Rose
- Nationwide Children's Hospital,The Ohio State University College of Medicine, Columbus, OH, USA
| | | | - Kathryn Addonizio
- Dana-Farber Boston Children's Cancer and Blood Disorder Center, Boston, MA, USA
| | - Anran Li
- Dana-Farber Boston Children's Cancer and Blood Disorder Center, Boston, MA, USA
| | - Hasan Al-Sayegh
- Dana-Farber Boston Children's Cancer and Blood Disorder Center, Boston, MA, USA
| | - Wendy B London
- Dana-Farber Boston Children's Cancer and Blood Disorder Center, Boston, MA, USA
| | - Rachael F Grace
- Dana-Farber Boston Children's Cancer and Blood Disorder Center, Boston, MA, USA
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7
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Christensen RD, Agarwal AM, George TI, Bhutani VK, Yaish HM. Acute neonatal bilirubin encephalopathy in the State of Utah 2009–2018. Blood Cells Mol Dis 2018; 72:10-13. [DOI: 10.1016/j.bcmd.2018.05.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 05/22/2018] [Accepted: 05/23/2018] [Indexed: 12/01/2022]
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8
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Meznarich JA, Draper L, Christensen RD, Yaish HM, Luem ND, Pysher TJ, Jung G, Nemeth E, Ganz T, Ward DM. Fetal presentation of congenital dyserythropoietic anemia type 1 with novel compound heterozygous CDAN1 mutations. Blood Cells Mol Dis 2018; 71:63-66. [PMID: 29599085 DOI: 10.1016/j.bcmd.2018.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 03/19/2018] [Indexed: 01/27/2023]
Abstract
The congenital dyserythropoietic anemias are a heterogeneous group of disorders characterized by anemia and ineffective erythropoiesis. Congenital dyserythropoietic anemia type I (CDA1) can present in utero with hydrops fetalis, but more often it presents in childhood or adulthood with moderate macrocytic anemia, jaundice, and progressive iron-overload. CDA1 is inherited in an autosomal recessive manner, with biallelic pathogenic variants in CDAN1 or C15orf41. This case report documents a severe fetal presentation of CDA1 where we identified two novel compound heterozygous mutations in CDAN1 and describes the associated pathologic findings and levels of iron-regulatory proteins hepcidin, erythroferrone, and GDF15.
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Affiliation(s)
- Jessica A Meznarich
- Division of Hematology-Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA; Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, UT, USA.
| | - Lauren Draper
- Division of Hematology-Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA; Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Robert D Christensen
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA; Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Hassan M Yaish
- Division of Hematology-Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA; Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Nick D Luem
- ARUP Laboratories, Salt Lake City, UT, USA; Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Theodore J Pysher
- Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, UT, USA; Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Grace Jung
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | | | - Tomas Ganz
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Diane M Ward
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
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9
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Abstract
Various mutations in the genes encoding alpha spectrin (SPTA1) or beta spectrin (SPTB) are known to cause erythrocyte membrane disorders, sometimes associated with severe neonatal jaundice and anemia. We used a next-generation sequencing panel to evaluate 3 unrelated neonates who had puzzling cases of nonimmune hemolytic jaundice. In each case, we identified novel mutations in either SPTA1 or SPTB. Correlating erythrocyte morphology, clinical course, and computational analysis, we submit that each of the 3 variants is a probable pathogenic cause of the hereditary hemolytic conditions in these patients. We hope other pediatric practitioners caring for neonates with what appears to be idiopathic severe neonatal hyperbilirubinemia will look for spectrin variants as a possible cause, because additional cases with these specific variants along with this clinical phenotype are needed to confirm our postulate that these 3 cases are indeed pathogenic mutations.
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Affiliation(s)
- Robert D Christensen
- 1 University of Utah, Salt Lake City, UT, USA.,2 Intermountain Healthcare, Salt Lake City, UT, USA
| | - Archana M Agarwal
- 1 University of Utah, Salt Lake City, UT, USA.,3 ARUP Laboratories, Salt Lake City, UT, USA
| | | | - N Scott Reading
- 1 University of Utah, Salt Lake City, UT, USA.,3 ARUP Laboratories, Salt Lake City, UT, USA
| | - Elizabeth A O'Brien
- 1 University of Utah, Salt Lake City, UT, USA.,2 Intermountain Healthcare, Salt Lake City, UT, USA
| | - Josef T Prchal
- 1 University of Utah, Salt Lake City, UT, USA.,3 ARUP Laboratories, Salt Lake City, UT, USA.,4 Salt Lake VA Hospital, Salt Lake City, UT, USA
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10
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Cattivelli K, Campagna DR, Schmitz-Abe K, Heeney MM, Yaish HM, Caruso Brown AE, Kearney S, Walkovich K, Markianos K, Fleming MD, Neufeld EJ. Ringed sideroblasts in β-thalassemia. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26324. [PMID: 27808451 PMCID: PMC5697724 DOI: 10.1002/pbc.26324] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 10/02/2016] [Accepted: 10/04/2016] [Indexed: 01/19/2023]
Abstract
Symptomatic β-thalassemia is one of the globally most common inherited disorders. The initial clinical presentation is variable. Although common hematological analyses are typically sufficient to diagnose the disease, sometimes the diagnosis can be more challenging. We describe a series of patients with β-thalassemia whose diagnosis was delayed, required bone marrow examination in one affected member of each family, and revealed ringed sideroblasts, highlighting the association of this morphological finding with these disorders. Thus, in the absence of characteristic congenital sideroblastic mutations or causes of acquired sideroblastic anemia, the presence of ringed sideroblasts should raise the suspicion of β-thalassemia.
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Affiliation(s)
- Kim Cattivelli
- Pediatrics Clinic, University of Brescia, Spedali Civili di Brescia, Italy,Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston Children’s Hospital, Boston, MA, USA
| | - Dean R. Campagna
- Department of Pathology, Boston Children’s Hospital, Boston, MA, USA
| | - Klaus Schmitz-Abe
- Division of Newborn Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew M. Heeney
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston Children’s Hospital, Boston, MA, USA
| | - Hassan M. Yaish
- Division of Hematology/Oncology, Department of Pediatrics, Primary Children’s Hospital, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Amy E. Caruso Brown
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Upstate Medical University, Syracuse, NY, USA
| | - Susan Kearney
- Division of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Kelly Walkovich
- Division of Pediatric Hematology/Oncology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA
| | - Kyriacos Markianos
- Department of Pathology, Boston Children’s Hospital, Boston, MA, USA,Division of Genetics and Genomics, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark D. Fleming
- Department of Pathology, Boston Children’s Hospital, Boston, MA, USA,Corresponding Authors: Mark D. Fleming () and Ellis J. Neufeld ()
| | - Ellis J. Neufeld
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston Children’s Hospital, Boston, MA, USA,Corresponding Authors: Mark D. Fleming () and Ellis J. Neufeld ()
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11
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Yaish HM, Farrell CP, Christensen RD, MacQueen BC, Jackson LK, Trochez-Enciso J, Kaplan J, Ward DM, Salah WK, Phillips JD. Two novel mutations in TMPRSS6 associated with iron-refractory iron deficiency anemia in a mother and child. Blood Cells Mol Dis 2017; 65:38-40. [PMID: 28460265 DOI: 10.1016/j.bcmd.2017.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/07/2017] [Accepted: 04/08/2017] [Indexed: 01/06/2023]
Abstract
In an iron deficient child, oral iron repeatedly failed to improve the condition. Whole exome sequencing identified one previously reported plus two novel mutation in the TMPRSS6 gene, with no mutations in other iron-associated genes. We propose that these mutations result in a novel variety of iron-refractory iron deficiency anemia.
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Affiliation(s)
- Hassan M Yaish
- Division of Hematology/Oncology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Colin P Farrell
- Center for Iron and Heme Disorders, University of Utah, and Division of Hematology/Oncology, Department of Medicine and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Robert D Christensen
- Division of Hematology/Oncology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA; Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Brianna C MacQueen
- Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Laurie K Jackson
- Center for Iron and Heme Disorders, University of Utah, and Division of Hematology/Oncology, Department of Medicine and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jesus Trochez-Enciso
- Center for Iron and Heme Disorders, University of Utah, and Division of Hematology/Oncology, Department of Medicine and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jerry Kaplan
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Diane M Ward
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Walid K Salah
- Division of Hematology/Oncology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - John D Phillips
- Center for Iron and Heme Disorders, University of Utah, and Division of Hematology/Oncology, Department of Medicine and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, USA; Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
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12
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Gallagher-Lacey C, Afify Z, Yaish HM, Yoder BA, Christensen RD. An Instructive Case of Transient Myeloproliferative Disorder. Clin Pediatr (Phila) 2017; 56:288-289. [PMID: 27530503 DOI: 10.1177/0009922816662460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Caitlin Gallagher-Lacey
- 1 University of Utah School of Medicine, Salt Lake City, UT, USA.,2 Primary Children's Hospital, Salt Lake City, UT, USA
| | - Zeinab Afify
- 1 University of Utah School of Medicine, Salt Lake City, UT, USA.,2 Primary Children's Hospital, Salt Lake City, UT, USA
| | - Hassan M Yaish
- 1 University of Utah School of Medicine, Salt Lake City, UT, USA.,2 Primary Children's Hospital, Salt Lake City, UT, USA
| | - Bradley A Yoder
- 1 University of Utah School of Medicine, Salt Lake City, UT, USA.,2 Primary Children's Hospital, Salt Lake City, UT, USA
| | - Robert D Christensen
- 1 University of Utah School of Medicine, Salt Lake City, UT, USA.,2 Primary Children's Hospital, Salt Lake City, UT, USA
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13
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Christensen RD, Yaish HM, Nussenzveig RH, Agarwal AM. Siblings with severe pyruvate kinase deficiency and a complex genotype. Am J Med Genet A 2016; 170:2449-52. [PMID: 27354418 DOI: 10.1002/ajmg.a.37828] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 06/16/2016] [Indexed: 01/19/2023]
Abstract
Siblings presented as neonates with severe jaundice and transfusion-dependent hemolytic anemia. Next-generation sequencing revealed both to have three heterozygous mutations in the gene encoding erythrocyte pyruvate kinase (PKLR), plus a heterozygous splice mutation in the beta-spectrin gene (SPTB). In addition, both have a different 5th mutation in a gene encoding other erythrocyte membrane proteins. The asymptomatic parents and all three asymptomatic siblings have different sets of these mutations. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Robert D Christensen
- Division of Hematology/Oncology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.,Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, Utah
| | - Hassan M Yaish
- Division of Hematology/Oncology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Archana M Agarwal
- ARUP Laboratories, Salt Lake City, Utah.,Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah
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14
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Agarwal AM, Nussenzveig RH, Reading NS, Patel JL, Sangle N, Salama ME, Prchal JT, Perkins SL, Yaish HM, Christensen RD. Clinical utility of next-generation sequencing in the diagnosis of hereditary haemolytic anaemias. Br J Haematol 2016; 174:806-14. [DOI: 10.1111/bjh.14131] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 03/02/2016] [Indexed: 02/02/2023]
Affiliation(s)
- Archana M. Agarwal
- Department of Pathology; University of Utah and ARUP Laboratories; Salt Lake City UT USA
| | - Roberto H. Nussenzveig
- Associated Regional and University Pathologists (ARUP) Laboratories; Salt Lake City UT USA
| | - Noel S. Reading
- Associated Regional and University Pathologists (ARUP) Laboratories; Salt Lake City UT USA
| | - Jay L. Patel
- Department of Pathology; University of Utah and ARUP Laboratories; Salt Lake City UT USA
| | - Nikhil Sangle
- Department of Pathology and Laboratory Medicine; Western University; London ON Canada
| | - Mohamed E. Salama
- Department of Pathology; University of Utah and ARUP Laboratories; Salt Lake City UT USA
| | - Josef T. Prchal
- Division of Hematology; Department of Medicine; University of Utah Health Sciences; Salt Lake City UT USA
| | - Sherrie L Perkins
- Department of Pathology; University of Utah and ARUP Laboratories; Salt Lake City UT USA
| | - Hassan M. Yaish
- Division of Hematology/Oncology; Department of Pediatrics; University of Utah School of Medicine; Salt Lake City UT USA
| | - Robert D. Christensen
- Divisions of Neonatology and Hematology Oncology; University of Utah School of Medicine; Salt Lake City UT USA
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15
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Abstract
Hemolysis can be an important cause of hyperbilirubinemia in premature and term neonates. It can result from genetic abnormalities intrinsic to or factors exogenous to normal to red blood cells (RBCs). Hemolysis can lead to a relatively rapid increase in total serum/plasma bilirubin, hyperbilirubinemia that is somewhat slow to fall with phototherapy, or hyperbilirubinemia that is likely to rebound after phototherapy. Laboratory methods for diagnosing hemolysis are more difficult to apply, or less conclusive, in preterm infants. Transfusion of donor RBCs can present a bilirubin load that must be metabolized. Genetic causes can be identified by next-generation sequencing panels.
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Affiliation(s)
- Robert D Christensen
- Division of Hematology/Oncology, Department of Pediatrics, Primary Children's Hospital, University of Utah School of Medicine, Chipeta Way, Salt Lake City, UT 84108, USA; Women and Newborn's Clinical Program, Division of Neonatology, Department of Pediatrics, Intermountain Healthcare, University of Utah School of Medicine, Chipeta Way, Salt Lake City, UT 84108, USA.
| | - Hassan M Yaish
- Division of Hematology/Oncology, Department of Pediatrics, Primary Children's Hospital, University of Utah School of Medicine, Chipeta Way, Salt Lake City, UT 84108, USA
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16
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Christensen RD, Henry E, Bennett ST, Yaish HM. Reference intervals for reticulocyte parameters of infants during their first 90 days after birth. J Perinatol 2016; 36:61-6. [PMID: 26513452 DOI: 10.1038/jp.2015.140] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 08/26/2015] [Accepted: 09/01/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The automated reticulocyte parameters (absolute reticulocyte count, immature reticulocyte fraction (IRF) and reticulocyte hemoglobin content (RET-He)) are of value in managing adults and older children with a variety of hematological disorders. However, the lack of reference intervals for these parameters in neonates and young infants has limited their application to that population. STUDY DESIGN During a span of 12 months (29 May 2014 to 5 May 2015), a convenience sample of reticulocyte parameters were run from clinically ordered complete blood counts (CBCs) of infants within the first 90 days after birth. Measuring the reticulocyte parameters as a research-only adjunct to the CBC did not require any additional blood or generate a patient charge, and the reticulocyte results were not reported to the provided and did not appear in the clinical records. Values from neonates who had a transfusion or a diagnosis of anemia were subsequently excluded from the reference data set. RESULTS Nine Intermountain Healthcare clinical laboratories contributed 8438 CBCs to the initial reticulocyte parameter database. From these, 1806 were excluded because of a transfusion or a diagnosis of anemia, leaving 6632 in the reference interval database. The parameters charted over the first 90 days after birth were: (1) blood hemoglobin concentration (g dl(-1)), (2) mean corpuscular volume (fL), (3) reticulocyte count (x10(3) per μl), (4) IRF (%) and (5) RET-He (pg). CONCLUSIONS The new reference interval charts can help clinicians identify abnormalities in the reticulocyte parameters. This information could be of value in identifying and following neonates with various hematological problems including hemolytic disorders, occult hemorrhage, or iron deficiency or other limitations of erythrocyte production.
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Affiliation(s)
- R D Christensen
- Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA.,Women and Newborn's Program, Intermountain Healthcare, Salt Lake City, UT, USA.,Division of Hematology/Oncology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - E Henry
- Women and Newborn's Program, Intermountain Healthcare, Salt Lake City, UT, USA.,Institute for Healthcare Delivery Research, Salt Lake City, UT, USA
| | - S T Bennett
- Department of Pathology, Intermountain Medical Center, Murray, UT, USA
| | - H M Yaish
- Division of Hematology/Oncology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
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17
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Abstract
A shortened erythrocyte life span, because of hemolytic disorders, is a common cause of extreme neonatal hyperbilirubinemia. Clinical and laboratory examinations can frequently identify the underlying cause of extreme neonatal hyperbilirubinemia. In this article, several tests, techniques, and approaches have been reviewed, including red blood cell morphology assessment, end-tidal carbon monoxide quantification, eosin-5-maleimide flow cytometry, as well as next-generation DNA sequencing using neonatal jaundice panels.
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Affiliation(s)
- Robert D Christensen
- Women and Newborn's Program, Division of Neonatology, Department of Pediatrics, Intermountain Healthcare, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84108, USA; Division of Hematology/Oncology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Hassan M Yaish
- Division of Hematology/Oncology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
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18
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Abstract
Newborn infants who have hereditary spherocytosis (HS) can develop anemia and hyperbilirubinemia. Bilirubin-induced neurologic dysfunction is less likely in these neonates if the diagnosis of HS is recognized and appropriate treatment provided. Among neonates listed in the USA Kernicterus Registry, HS was the third most common underlying hemolytic condition after glucose-6-phosphate dehydrogenase deficiency and ABO hemolytic disease. HS is the leading cause of direct antiglobulin test (direct Coombs) negative hemolytic anemia requiring erythrocyte transfusion in the first months of life. We anticipate that as physicians become more familiar with diagnosing HS in the newborn period, fewer neonates with HS will develop hazardous hyperbilirubinemia or present to emergency departments with unanticipated symptomatic anemia. We predict that early suspicion, prompt diagnosis and treatment, and anticipatory guidance will prevent adverse outcomes in neonates with HS. The purpose of this article was to review the neonatal presentation of HS and to provide practical and up-to-date means of diagnosing and treating HS in neonates.
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Affiliation(s)
- Robert D. Christensen
- Divisions of Neonatology and,Hematology/Oncology, Department of Pediatrics, University of Utah School of Medicine, Primary Children’s Hospital, Intermountain Healthcare, Salt Lake City, Utah; and
| | - Hassan M. Yaish
- Hematology/Oncology, Department of Pediatrics, University of Utah School of Medicine, Primary Children’s Hospital, Intermountain Healthcare, Salt Lake City, Utah; and
| | - Patrick G. Gallagher
- Division of Neonatology, Department of Pediatrics, Yale University School of Medicine, Yale–New Haven Children’s Hospital, New Haven, Connecticut
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19
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Boylan B, Rice AS, De Staercke C, Eyster ME, Yaish HM, Knoll CM, Bean CJ, Miller CH. Evaluation of von Willebrand factor phenotypes and genotypes in Hemophilia A patients with and without identified F8 mutations. J Thromb Haemost 2015; 13:1036-42. [PMID: 25780857 PMCID: PMC4512234 DOI: 10.1111/jth.12902] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Hemophilia A (HA) is an X-linked bleeding disorder caused by a deficiency in factor VIII (FVIII). von Willebrand disease (VWD) is characterized by a quantitative or qualitative defect in von Willebrand factor (VWF). Patients with VWD with severely low VWF or VWD Type 2N (VWD2N), a VWD subtype distinguished by defective VWF binding to FVIII, may have reduced FVIII levels secondary to their VWD. These patients superficially resemble patients with HA and pose a potential for misdiagnosis. OBJECTIVES To investigate the unexplained cause of bleeding in HA patients without known FVIII mutations by assessing plasma VWF antigen (VWF:Ag), FVIII binding capacities and VWF genotypes. PATIENTS/METHODS Thirty-seven of 1027 patients with HA studied as part of the Hemophilia Inhibitor Research Study lacked identifiable F8 mutations. These patients (cases) and 73 patients with identified F8 mutations (controls) were evaluated for VWF:Ag, a patient's VWF capacity to bind FVIII (VWF:FVIIIB) and VWF sequence. RESULTS Four cases had VWF:Ag < 3 IU dL(-1) and VWF mutations consistent with Type 3 VWD. Six cases and one control were heterozygous for mutations previously reported to cause Type 1 VWD (VWD1) (n = five cases and one control) or predicted to be deleterious by Polyphen2 and SIFT prediction tools (n = 1 case). One control had VWF:Ag < 30 IU dL(-1) and seven patients (four cases and three controls), including two cases who were heterozygous for a known VWD2N mutation, had reduced VWF:FVIIIB. CONCLUSIONS These data emphasize that some patients diagnosed with HA require VWF assessments in order to achieve a comprehensive diagnosis and an optimal treatment strategy.
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Affiliation(s)
- Brian Boylan
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anne S. Rice
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christine De Staercke
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - M. Elaine Eyster
- Department of Medicine, Division of Hematology and Oncology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Hassan M. Yaish
- Department of Pediatrics, Division of Hematology/Oncology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Christine M. Knoll
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, Arizona
| | - Christopher J. Bean
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Connie H. Miller
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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20
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Christensen RD, Baer VL, Yaish HM. Thrombocytopenia in late preterm and term neonates after perinatal asphyxia. Transfusion 2014; 55:187-96. [DOI: 10.1111/trf.12777] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 05/28/2014] [Accepted: 05/30/2014] [Indexed: 12/12/2022]
Affiliation(s)
| | - Vickie L. Baer
- Women and Newborn's Clinical Program; Intermountain Healthcare; Salt Lake City Utah
| | - Hassan M. Yaish
- Department of Pediatrics, Division of Hematology/Oncology; University of Utah School of Medicine; Salt Lake City Utah
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21
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Abstract
OBJECTIVE To create reference intervals for red blood cell distribution width (RDW) of neonates and to use these intervals to better understand and classify hematopathology of neonates. STUDY DESIGN This was a retrospective analysis of data from neonates born between 1/1/2001 and 12/31/2011, who had a complete blood cell count (CBC) in the first 14 days. The first RDW recorded from each was displayed according to gestational and postnatal age. Correlation between RDW and reticulocyte count was sought when the two tests were obtained simultaneously. Focused studies were performed on the 20 neonates with the highest and the 10 with the lowest RDW values. RESULTS RDW values from 165,613 CBCs were included. RDW reference intervals for neonates are higher than for older children and adults. At birth, the lower reference limit for term and late preterm neonates is 15.5%. The upper reference limit is 20%, and is slightly higher (up to 23%) in preterm neonates. For term and late preterm neonates the range does not change in the first two weeks but preterm neonates have a rise in upper reference limit concordant with erythrocyte transfusions. RDW and reticulocytes correlated positively but weakly (r(2 )= 0.187). Eighteen of the 20 with the highest RDW values (29.4-42.8%) at birth had anemia with prenatal hemorrhage or hemolysis. Those with the lowest RDW values (11.8-13.7%) at birth tended to have a low MCV for age (95.5 ± 11.4 fL versus.129.8 ± 19.3 fL with a high RDW, p < 0.00001). CONCLUSION The RDW reference interval at birth is 15.5-20% and does not change appreciably over the first two weeks except for those receiving a transfusion where the RDW increases. High RDW values at birth indicate anisocytosis commonly due to macrocytic reticulocytosis; low values correlate with relative microcytosis.
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Affiliation(s)
- Robert D Christensen
- Department of Women and Newborns, Intermountain Healthcare, McKay-Dee Hospital Center , Ogden, UT , USA
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22
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Nussenzveig RH, Christensen RD, Prchal JT, Yaish HM, Agarwal AM. Novel α-spectrin mutation in trans with α-spectrin causing severe neonatal jaundice from hereditary spherocytosis. Neonatology 2014; 106:355-7. [PMID: 25277063 DOI: 10.1159/000365586] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 07/01/2014] [Indexed: 11/19/2022]
Abstract
We evaluated a neonate with severe jaundice but a negative family history. Spherocytes were present and suspected hereditary spherocytosis was confirmed by osmotic fragility and eosin-5-maleimide erythrocyte staining. We found he was a compound heterozygote for two pathogenic mutations in the gene encoding α-spectrin: a previously reported α(LEPRA) inherited from his asymptomatic mother, and a novel α-spectrin mutation in intron 45 +1 disrupting the consensus splice site, from his asymptomatic father.
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23
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Yaish HM, Nussenzveig RH, Agarwal AM, Siddiqui AH, Christensen RD. A previously unknown mutation in the pyruvate kinase gene (PKLR) identified from a neonate with severe jaundice. Neonatology 2014; 106:140-2. [PMID: 24969675 DOI: 10.1159/000363219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 04/28/2014] [Indexed: 11/19/2022]
Abstract
We report a neonate with early and severe hemolytic jaundice and low erythrocyte pyruvate kinase enzymatic activity (<2 U/g hemoglobin, reference interval 9-22). We found her asymptomatic mother to be heterozygous for a novel PKLR mutation (c.1573delT) with an erythrocyte PK activity of 6.2 U/g hemoglobin. Her asymptomatic father was heterozygous for the common Northern European PKLR mutation (c.1529A) with an erythrocyte PK activity of 3.6 U/g. The neonate was a compound heterozygote with both mutations, but with no other mutations identified by sequencing a panel of 27 genes involved in severe neonatal jaundice.
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Affiliation(s)
- Hassan M Yaish
- Department of Pediatrics, Division of Hematology/Oncology, University of Utah School of Medicine, Salt Lake City, Utah, USA
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24
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Christensen RD, Nussenzveig RH, Reading NS, Agarwal AM, Prchal JT, Yaish HM. Variations in both α-spectrin (SPTA1) and β-spectrin ( SPTB ) in a neonate with prolonged jaundice in a family where nine individuals had hereditary elliptocytosis. Neonatology 2014; 105:1-4. [PMID: 24193021 DOI: 10.1159/000354884] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 08/06/2013] [Indexed: 11/19/2022]
Abstract
We cared for a neonate who had problematic hyperbilirubinemia born into a family where nine first-degree relatives had hereditary elliptocytosis (HE). As neonates, the nine relatives did not have any significant jaundice or anemia that was recognizable. Blood films on the proband suggested a diagnosis of pyropoikilocytosis. Analysis of the α-spectrin gene (SPTA1) in the proband revealed two previously reported low-frequency heterozygous polymorphisms of unknown clinical significance and the α(LELY) allele. In addition, a novel heterozygous mutation was identified in exon 2 of the β-spectrin gene SPTB. No mutations were identified in ANK1 (ankyrin-1), SLC4A1 (band 3), EPB41 (band 4.1), or EPB42 (band 4.2).
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Affiliation(s)
- Robert D Christensen
- Department of Women and Newborns, Intermountain Healthcare, Salt Lake City, Utah, USA
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25
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Christensen RD, Yaish HM, Lemons RS. Neonatal hemolytic jaundice: morphologic features of erythrocytes that will help you diagnose the underlying condition. Neonatology 2014; 105:243-9. [PMID: 24526179 DOI: 10.1159/000357378] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 11/13/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Many cases of severe neonatal hyperbilirubinemia never have the underlying cause of the jaundice clearly identified. Thus they are said to have 'idiopathic' severe neonatal jaundice. However, finding the exact cause, if it is a genetic condition, can enable informed anticipatory guidance regarding future episodes of hemolysis, anemia, or bilirubin cholelithiasis. OBJECTIVE 'Next generation' gene sequencing can often reveal the mutations responsible for severe neonatal hyperbilirubinemia, but wisely using this new technology involves selective application, employing this testing only if inexpensive technology fails to reveal the diagnosis. METHODS In this review, we display and discuss five types of red blood cell morphological abnormalities that have helped us categorize cases of neonatal hemolytic jaundice. RESULTS As an aid to applying inexpensive technology, we review morphological abnormalities of erythrocytes that are easily identified on a blood film. When found, these abnormalities can be important clues to the underlying hemolytic condition giving rise to neonatal jaundice. CONCLUSIONS Applying these simple and inexpensive methods can assist neonatologists in caring for neonates who have hemolytic jaundice. We predict that by using these principals the term 'idiopathic' neonatal jaundice will become less common as the underlying causes are identified.
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Affiliation(s)
- Robert D Christensen
- Women and Newborns Program, Intermountain Healthcare, and Division of Hematology/Oncology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Christensen RD, Yaish HM, Wiedmeier SE, Reading NS, Pysher TJ, Palmer CA, Prchal JT. Neonatal death suspected to be from sepsis was found to be kernicterus with G6PD deficiency. Pediatrics 2013; 132:e1694-8. [PMID: 24218468 DOI: 10.1542/peds.2013-1030] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We cared for a term male infant born to Burmese immigrants. At about 24 hours a total serum bilirubin (TSB) was 9.3 mg/dL, and phototherapy was begun. It was stopped 48 hours later, with a TSB of 10.9 mg/dL, and he was discharged from the hospital with an appointment for a repeat TSB check 48 hours later. A few hours before the appointment he became listless and apneic, and his parents took him to the emergency department of the regional children's hospital, where sepsis was suspected. The TSB was 41 mg/dL. He died 4 hours later, despite intensive care efforts, with opisthotonus and refractory hypotension. Blood drawn before the exchange transfusion had low glucose-6-phosphate dehydrogenase (G6PD) enzymatic activity, and sequencing of the G6PD gene revealed the G6PD Mahidol mutation (c.487G>A). Cultures and postmortem examination did not demonstrate an infectious process, but kernicterus was present. Acute kernicterus can mimic septic shock.
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Christensen RD, Yaish HM, Nussenzveig RH, Reading NS, Agarwal AM, Eggert LD, Prchal JT. Acute kernicterus in a neonate with O/B blood group incompatibility and a mutation in SLC4A1. Pediatrics 2013; 132:e531-4. [PMID: 23878048 DOI: 10.1542/peds.2012-3799] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We cared for a term female newborn, who at 108 hours of age, with a total serum bilirubin of 15.4 mg/dL, was discharged from the hospital on home phototherapy. At a return appointment 44 hours later, her total serum bilirubin was 41.7 mg/dL and signs of acute kernicterus were present. Maternal/fetal blood group O/B incompatibility was identified, with a negative direct antiglobulin test, which was positive on retesting. She had abundant spherocytes on blood smear, and these persisted at follow-up, but neither parent had spherocytes identified. A heterozygous SLC4A1(E508K) mutation (gene encoding erythrocyte membrane protein band 3) was found, and in silico predicted to result in damaged erythrocyte cytoskeletal protein function. No mutations were identified in other red cell cytoskeleton genes (ANK1, SPTA1, SPTB, EPB41, EPB42) and the UGT1A1 promoter region was normal. Neurologic follow-up at 2 and 4 months showed developmental delays consistent with mild kernicterus.
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Affiliation(s)
- Robert D Christensen
- Women and Newborns Program, Intermountain Healthcare, Salt Lake City, Utah 84403, USA.
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Yaish HM, Christensen RD, Agarwal A. A neonate with Coombs-negative hemolytic jaundice with spherocytes but normal erythrocyte indices: a rare case of autosomal-recessive hereditary spherocytosis due to alpha-spectrin deficiency. J Perinatol 2013; 33:404-6. [PMID: 23624969 DOI: 10.1038/jp.2012.67] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The diagnosis of hereditary spherocytosis (HS) in a newborn infant is generally made on the basis of a positive family history, spherocytes on blood film and Coombs-negative hemolytic jaundice of variable severity with an elevated mean corpuscular hemoglobin concentration (MCHC) and a low mean corpuscular volume (MCV). In general, sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) quantification of erythrocyte membrane proteins is not needed to make the clinical diagnosis of HS. However, we observed that a neonate with no family history of HS, but with abundant spherocytosis on repeated blood films, Coombs-negative hemolytic jaundice and normal MCHC and MCV measurements, where SDS-PAGE revealed alpha-spectrin deficiency, a rare autosomal-recessive variety of HS that generally has a severe clinical phenotype.
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Affiliation(s)
- H M Yaish
- Division of Hematology/Oncology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
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Christensen RD, Yaish HM, Leon EL, Sola-Visner MC, Agrawal PB. A de novo T73I mutation in PTPN11 in a neonate with severe and prolonged congenital thrombocytopenia and Noonan syndrome. Neonatology 2013; 104:1-5. [PMID: 23446178 DOI: 10.1159/000346375] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 12/03/2012] [Indexed: 11/19/2022]
Abstract
We observed a neonate with severe congenital thrombocytopenia and features of Noonan syndrome where evaluations were negative for immune-mediated thrombocytopenia, congenital infections, and Fanconi anemia. The marrow findings and a significantly elevated plasma thrombopoietin (Tpo) level were consistent with congenital amegakaryocytic thrombocytopenia; we sought a genetic mutation that could explain this phenotype. No mutations were identified in c-MPL (the Tpo receptor gene). Microarray analysis of peripheral blood did not reveal an abnormality. DNA sequencing of the PTPN11 gene showed a heterozygous C>T nucleotide substitution in exon 3 (c.218C>T) predicted to result in a threonine-to-isoleucine change at residue 73 (T73I). A 6-week trial of eltrombopag (an agonist of the Tpo receptor) failed to increase the platelet count. We propose this specific PTPN11 mutation results in abnormalities of the protein product SHP-2, which, because of its role in signal transduction, results in severe congenital thrombocytopenia refractory to c-MPL agonists.
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Affiliation(s)
- Robert D Christensen
- Department of Women and Newborns, Intermountain Healthcare,University of Utah School of Medicine, Salt Lake City, Utah 84403, USA.
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Christensen RD, Lambert DK, Henry E, Eggert LD, Yaish HM, Reading NS, Prchal JT. Unexplained extreme hyperbilirubinemia among neonates in a multihospital healthcare system. Blood Cells Mol Dis 2012; 50:105-9. [PMID: 23123126 DOI: 10.1016/j.bcmd.2012.10.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 10/17/2012] [Indexed: 10/27/2022]
Abstract
We report a series of neonates who developed a total serum bilirubin (TSB) >20mg/dL during a recent ten-year period in a multihospital healthcare system. The incidence of a TSB >20mg/dL fell after instituting a pre-hospital discharge bilirubin screening program in 2003/2004 (91.3 cases/10,000 births before vs. 72.4/10,000 after), but the incidence has subsequently remained unchanged. No specific cause for the hyperbilirubinemia was identified in 66% of (n=32) cases with a TSB >30 mg/dL or in 76% of (n=112) cases with a TSB 25.0-29.9 mg/dL. We hypothesized that hemolysis was a common contributing mechanism, but our review of hospital records indicated that in most instances these infants were not evaluated sufficiently to test this hypothesis. Records review showed maternal and neonatal blood types and direct antiglobulin testing were performed in >95% cases, but rarely were other tests for hemolysis obtained. In the ten-year period reviewed there were zero instances where erythrocyte morphology from a blood film examination or Heinz body evaluation by a pediatric hematologist or pathologist were performed. In 3% of cases pyruvate kinase was tested, 3% were evaluated by hemoglobin electrophoresis, 3% had a haptoglobin measurement, and 16% were tested for G6PD deficiency. Thus, determining the cause for hyperbilirubinemia in neonates remains a problem at Intermountain Healthcare and, we submit, elsewhere. As a result, the majority of infants with a TSB >25mg/dL have no specific causation identified. We speculate that most of these cases involve hemolysis and that the etiology could be identified if searched for more systematically. With this in mind, we propose a "consistent approach" to evaluating the cause(s) of hyperbilirubinemia among neonates with a TSB >25mg/dL.
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Affiliation(s)
- Robert D Christensen
- Women and Newborn's Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA.
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Christensen RD, Yaish HM. A neonate with the Pelger-Huët anomaly, cleft lip and palate, and agenesis of the corpus callosum, with a chromosomal microdeletion involving 1q41 to 1q42.12. J Perinatol 2012; 32:238-40. [PMID: 22370897 DOI: 10.1038/jp.2011.119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We observed a neonate with cleft lip and palate, 13 sets of ribs, agenesis of the corpus callosum, slightly small penis, hypoglycemia, and what initially appeared to be a marked leukocyte 'left shift' on complete blood count, but which was actually a Pelger-Huët anomaly. A chromosomal microdeletion was identified at1q41-42.12.
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Affiliation(s)
- R D Christensen
- Department of Women and Newborns, Intermountain Healthcare, Salt Lake City, UT 84403, USA.
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Smock KJ, Yaish HM, Cairo MS, Lones MA, Willmore-Payne C, Perkins SL. Mantle cell lymphoma presenting with unusual morphology in an adolescent female: a case report and review of the literature. Pediatr Dev Pathol 2007; 10:403-8. [PMID: 17929987 DOI: 10.2350/06-08-0142.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Accepted: 11/30/2006] [Indexed: 11/20/2022]
Abstract
We report the case of an 18-year-old female initially diagnosed with CD5-negative diffuse large B-cell lymphoma in an inguinal lymph node in 1999 who subsequently relapsed with classic-morphology mantle cell lymphoma with involvement of the bone marrow, gastrointestinal tract, and spleen in 2004. Both the 1999 and 2004 lesions were retrospectively positive for Cyclin D1 by immunohistochemistry and positive for t(11:14)(q13;q32) by fluorescence in situ hybridization, and both lesions had identical B-cell receptor gene rearrangements by polymerase chain reaction. This case of a CD5-negative large cell or pleomorphic blastoid variant of mantle cell lymphoma arising in an 18-year-old represents a very early incidence for this type of lymphoma, which is usually not seen in younger patients.
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Affiliation(s)
- Kristi J Smock
- University of Utah Health Sciences Center, 50 North Medical Drive, Salt Lake City, UT 84132, USA.
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Abstract
Ten Saudi children with clinical and laboratory findings related to lead intoxication were seen at the King Fahad National Guard Hospital from 1984 to 1988. A presumptive diagnosis of chronic lead poisoning was made retrospectively on 12 other children with hypochromic and microcytic anemia whose other laboratory data were consistent with lead poisoning. The ages of the children ranged from six months to 13 years. After the first child with lead encephalopathy was diagnosed, a high index of suspicion was maintained, thus enabling us to establish an early diagnosis of lead encephalopathy. The findings of this study suggest that excessive lead exposure may still pose a serious public health hazard in Saudi Arabia today which needs to be addressed.
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Affiliation(s)
- H M Yaish
- Department of Pediatrics and Department of Medical Education, King Fahad National Guard Hospital, Riyadh, Saudi Arabia
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Yaish HM, Niazi GA, al Soby A. Lead encephalopathy in Saudi Arabian children. Am J Dis Child 1992; 146:1257-9. [PMID: 1415057 DOI: 10.1001/archpedi.1992.02160230015003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Khan SN, Yaish HM. Misdiagnosis of congenital chloride-losing diarrhea. J Perinatol 1992; 12:112-4. [PMID: 1522426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Congenital chloride-losing diarrhea is a recessively inherited disorder due to the absence of chloride-bicarbonate exchange in the small bowel. Malabsorption of chloride leads to osmotic diarrhea, electrolyte abnormalities, and dehydration. If left untreated, the infants fail to thrive and have a very high mortality. Clinically, affected patients develop secretory diarrhea in utero resulting in distended bowel loops and polyhydramnios. At birth these infants have profuse watery diarrhea that may be confused with urine. Thus, the correct diagnosis is often missed, and they may be subjected to unnecessary interventions. If diagnosed early, the electrolyte abnormalities are easily corrected and the prognosis is good. We report two patients who were initially evaluated for other conditions but later proved to have congenital chloride-losing diarrhea. The cases emphasize the importance of having a high index of suspicion in patients with a history of polyhydramnios, prematurity, and watery stools.
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Affiliation(s)
- S N Khan
- Department of Pediatrics, King Fahad National Guard Hospital, Riyadh, Saudi Arabia
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Niazi GA, Yaish HM, Kutlar F, Huisman TH. Heterogeneity of gamma-globin chain synthesis in Saudi newborns. Int J Hematol 1991; 54:377-83. [PMID: 1721852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cord blood samples from 655 unselected neonates born to Saudi mothers at King Fahad National Guard Hospital, Riyadh, Saudi Arabia were analysed to determine the levels of gamma-globin chains in Saudis. The percentage of three types of gamma-chains of human fetal hemoglobin (A gamma T, G gamma and A gamma I) was obtained by high-performance liquid chromatographic (HPLC) method. Although the majority of babies (631/655) had normal G gamma values in the range of 58-74%, there were only 69% with normal G gamma/A gamma ratio. The A gamma T chain or HbF Sardinia was present in 28% of the total neonates with a gene frequency of 0.160. The A gamma T values in this group ranged between 11-42%. Eight babies (1.2%) had G gamma levels 45% or less (mean 41 +/- 3%) and in 16 neonates (2.4%), G gamma values were highly elevated (mean 81.4 +/- 2.8%). The frequency of two G gamma-globin genes was 0.0061 and 0.0122, respectively, which is comparable with other ethnic or racial groups. The differences in G gamma to A gamma ratio in some Saudi babies could be due to an abnormal arrangement of gamma-globin genes of beta-globin gene cluster which is now being investigated.
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Affiliation(s)
- G A Niazi
- Department of Research, King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia
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Yaish HM, Niazi GA, al Shaalan M, Khan S, Ahmed GS. Increased incidence of hyperbilirubinaemia in 'unchallenged' glucose-6-phosphate dehydrogenase deficiency in term Saudi newborns. Ann Trop Paediatr 1991; 11:259-66. [PMID: 1719925 DOI: 10.1080/02724936.1991.11747511] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The incidence of severe hyperbilirubinaemia was significantly higher among the G6PD-deficient Saudi infants born at term than in non-deficient babies (34% vs 9%) (p less than 0.005). No apparent offending factors were detected in either the babies or their mothers. All babies who developed hyperbilirubinaemia did so during the 1st week of life. The highest mean bilirubin level for all jaundiced G6PD-deficient babies was recorded on the 4th postnatal day. Although the incidence of severe hyperbilirubinaemia among our neonates was relatively high, only two of them (7%), a boy and a girl, required exchange transfusions. Five of 29 jaundiced babies with G6PD deficiency were readmitted after discharge because of significant jaundice. One required exchange transfusion. Since G6PD deficiency seems to be a relatively common cause of neonatal jaundice in Saudi newborns, early detection of this enzymopathy by cord blood screening is justified to avoid morbidity and deaths.
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Affiliation(s)
- H M Yaish
- Department of Paediatrics, King Fahad National Guard Hospital, Riyadh, Saudi Arabia
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Abstract
Idiopathic thrombocytopenic purpura in children 10 years of age or younger was observed to have a more favorable prognosis than in older children. Corticosteroid therapy in children judged to be at increased risk of serious hemorrhage resulted in a significantly greater number of patients with an early increase in platelets than was noted in a control group. All patients with chronic disease who responded to administration of a corticosteroid initially and then relapsed had some response to a subsequent course of therapy, although none had a sustained remission. In such patients, splenectomy was a more effective therapeutic measure than treatment with either a corticosteroid or a cytotoxic agent.
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