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Deguise MO, Blain S, Simpson E, Liebman M, Ferretti E. Congenital dyserythropoietic anemia type IV in the genetic era: A rare neonatal case report of rapid identification with a review of the literature. Pediatr Blood Cancer 2023; 70:e30245. [PMID: 36798023 DOI: 10.1002/pbc.30245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/05/2022] [Revised: 12/07/2022] [Accepted: 01/11/2023] [Indexed: 02/18/2023]
Abstract
Congenital dyserythropoietic anemia type IV (CDAIV) is a rare inherited hematological disorder, presenting with severe anemia due to altered erythropoiesis and hemolysis, with variable needs for recurrent transfusions. We present a case of a transfusion-dependent male newborn who presented at birth with severe hemolytic anemia, and required an intrauterine transfusion. Genetic testing rapidly identified a Kruppel-like factor 1 (KLF1) pathogenic variant (c.973G>A, p.E325K), known to be causative for CDAIV. This case highlights the advantages of next-generation sequencing testing for congenital hemolytic anemia: diagnostic speed, guidance on natural history, and optimized clinical management and anticipatory guidance for parents and clinicians. Additionally, we reviewed the literature for all CDAIV cases.
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Affiliation(s)
- Marc-Olivier Deguise
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Sarah Blain
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Pediatric Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Ewurabena Simpson
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Division of Pediatric Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Mira Liebman
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Division of Pediatric Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Emanuela Ferretti
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Division of Neonatology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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2
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Luke N, Hillier K, Al-Samkari H, Grace RF. Updates and advances in pyruvate kinase deficiency. Trends Mol Med 2023; 29:406-418. [PMID: 36935283 DOI: 10.1016/j.molmed.2023.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 01/10/2023] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 03/19/2023]
Abstract
Mutations in the PKLR gene lead to pyruvate kinase (PK) deficiency, causing chronic hemolytic anemia secondary to reduced red cell energy, which is crucial for maintenance of the red cell membrane and function. Heterogeneous clinical manifestations can result in significant morbidity and reduced health-related quality of life. Treatment options have historically been limited to supportive care, including red cell transfusions and splenectomy. Current disease-modifying treatment considerations include an oral allosteric PK activator, mitapivat, which was recently approved for adults with PK deficiency, and gene therapy, which is currently undergoing clinical trials. Studies evaluating the role of PK activators in other congenital hemolytic anemias are ongoing. The long-term effect of treatment with disease-modifying therapy in PK deficiency will require continued evaluation.
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Affiliation(s)
- Neeti Luke
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Hassenfeld Children's Hospital at NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Kirsty Hillier
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Hassenfeld Children's Hospital at NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Hanny Al-Samkari
- Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 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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Maisonneuve E, Sohier Lepine M, Maurice P, Pissard S, Lafon B, Mailloux A, Dhombres F, Leverger G, Jouannic JM. Prenatal management of fetal anemia due to pyruvate kinase deficiency: A case report. Transfusion 2023; 63:257-262. [PMID: 36349479 DOI: 10.1111/trf.17177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/06/2022] [Revised: 10/02/2022] [Accepted: 10/10/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Pyruvate Kinase (PK) deficiency is the most common enzyme defect of glycolysis, leading to congenital hemolytic anemia, which can occur during the neonatal period. STUDY DESIGN AND METHODS We report the prenatal management of fetal anemia related to PK deficiency in a family with a severe proband. RESULTS The couple had a first child born with hydrops, whose PK deficiency was diagnosed at 18 months of life. He was treated with allogeneic bone marrow transplantation. The second child was free from disease. For the third pregnancy, the amniocentesis revealed a PK deficiency. Weekly ultrasound monitoring of the middle cerebral artery velocity allowed the detection of severe fetal anemia. Two intrauterine red blood cell transfusions (IUTs) were performed, raising the fetal hemoglobin from 6.6 to 14.5 g/dl at 28 weeks' gestation and from 8.9 to 15.3 g/dl at 31 weeks. A hematopoietic stem cell allograft was discussed prenatally but not chosen, as it would not have significantly changed the perinatal prognosis. The patient delivered a 2730 g girl at 37 weeks, with hemoglobin of 13.6 g/dl. The child presented with neonatal jaundice treated with phototherapy and received postnatal transfusions. DISCUSSION When a proband is identified in a family, fetal investigation is warranted, to set up third-trimester ultrasound surveillance and perinatal management. In case of fetal severe anemia of unknown etiology, the workup on fetal blood sampling before IUT should comprise the search for erythrocytes enzymopathies, such as PK deficiency. IUTs allow safer full-term delivery in cases with PK deficiency.
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Affiliation(s)
- Emeline Maisonneuve
- Institute for Primary Health Care (BIHAM), Bern, Switzerland.,Department Woman-Mother-Child, CHUV, Lausanne, Switzerland.,Department of Fetal Medicine, Armand Trousseau Hospital, Paris, France.,National Reference Center for Perinatal Hemobiology (CNRHP), Clinic Unit, Armand Trousseau Hospital, Paris, France
| | - Marlène Sohier Lepine
- Department of Fetal Medicine, Armand Trousseau Hospital, Paris, France.,Department of Obstetrics and Gynecology, Paule de Viguier Hospital, Toulouse, France
| | - Paul Maurice
- Department of Fetal Medicine, Armand Trousseau Hospital, Paris, France.,National Reference Center for Perinatal Hemobiology (CNRHP), Clinic Unit, Armand Trousseau Hospital, Paris, France
| | - Serge Pissard
- Department of Genetics, APHP, GHU Henri Mondor Hospital, and IMRB-InsermU955 eq2, Créteil, France
| | - Bertrand Lafon
- Department of Fetal Medicine, Armand Trousseau Hospital, Paris, France.,National Reference Center for Perinatal Hemobiology (CNRHP), Clinic Unit, Armand Trousseau Hospital, Paris, France
| | - Agnès Mailloux
- Centre National de Référence en Hémobiologie Périnatale (CNRHP), Biologic Unit, Armand Trousseau Hospital, Paris, France
| | - Ferdinand Dhombres
- Department of Fetal Medicine, Armand Trousseau Hospital, Paris, France.,National Reference Center for Perinatal Hemobiology (CNRHP), Clinic Unit, Armand Trousseau Hospital, Paris, France
| | - Guy Leverger
- Department of Hemato-Immuno-Oncology, Armand Trousseau Hospital, Paris, France
| | - Jean-Marie Jouannic
- Department of Fetal Medicine, Armand Trousseau Hospital, Paris, France.,National Reference Center for Perinatal Hemobiology (CNRHP), Clinic Unit, Armand Trousseau Hospital, Paris, France
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4
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Sánchez Villalobos M, Salido Fiérrez E, Martínez Nieto J, García Garay MC, Beltrán Videla A, Pérez Oliva AB, Blanquer Blanquer M, Moraleda Jiménez JM. Case Report: α-Spectrin Mutation Associated with αLELY Polymorphism Responsible for Hereditary Pyropoikilocytosis. Hematol Rep 2022; 14:300-304. [PMID: 36278520 PMCID: PMC9589974 DOI: 10.3390/hematolrep14040043] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 06/24/2022] [Revised: 08/03/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022] Open
Abstract
Hereditary pyropoikilocytosis (HPP) is characterised by severe hemolytic anemia due to membrane instability. We report the case of a 13-day-old boy with neonatal jaundice and severe hemolytic anemia. A peripheral smear examination showed severe anisopoikylocytosis. DNA sequencing revealed compound double heterozygous for mutant α-spectrin SPTA1 (Arg28His) and homozygous αLELY polymorphism (low expression α-spectrin allele), compatible with diagnosis of HPP.The patient required a blood transfusion initially, but spontaneously improved after two years. Our case illustrates that, despite the presence of the allele αLELY in homozygous, the clinical phenotype is similar to cases with a mutation in SPTA1 associated with αLELY in trans.
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Affiliation(s)
- María Sánchez Villalobos
- Servicio de Hematología, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain
- Correspondence: ; Tel.: +34-699158102
| | - Eduardo Salido Fiérrez
- Servicio de Hematología, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB)-Arrixaca, 30120 Murcia, Spain
| | | | - Mª Carmen García Garay
- Servicio de Hematología, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain
| | - Asunción Beltrán Videla
- Servicio de Hematología, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain
| | - Ana Belen Pérez Oliva
- Instituto Murciano de Investigación Biosanitaria (IMIB)-Arrixaca, 30120 Murcia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), 28029 Madrid, Spain
| | - Miguel Blanquer Blanquer
- Servicio de Hematología, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB)-Arrixaca, 30120 Murcia, Spain
| | - José María Moraleda Jiménez
- Servicio de Hematología, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB)-Arrixaca, 30120 Murcia, Spain
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Manci EA, Dolma K, Manjunath C, Liu SS, Galliani CA, Bhat R. Neonatal Myocardial Ischemia-Reperfusion Injury: A Proposed Pathogenic Sequence in the Context of Maternal/Fetal Vascular Malperfusion and Paradoxical Embolism. Pediatr Dev Pathol 2022; 25:162-167. [PMID: 34551278 DOI: 10.1177/10935266211042210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/16/2022]
Abstract
BACKGROUND Neonatal myocardial infarction (MI) in a structurally normal heart is frequently an obscure event that remains undiagnosed until autopsy. Causal attributions usually cite underlying maternal or fetal conditions. Refinement in understanding of pathogenic mechanisms underlying neonatal MI is key to advancements in diagnosis, prevention, treatments and prognosis. OBJECTIVE This study presents a 36-week gestational age female with perinatal asphyxia, congenital hemolytic anemia and umbilical vein thrombosis who sustained catastrophic MI with reperfusion injury; and it reviews pertinent literature. RESULTS We propose a pathogenic sequence that links maternal vascular malperfusion, fetal vascular malperfusion, hemolytic anemia, umbilical venous thrombosis, and paradoxical thromboemboli. CONCLUSION This case highlights the importance of placental examination in connecting complex neonatal events with adverse maternal/placental conditions. A high index of suspicion is essential for early diagnosis of neonatal MI.
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Affiliation(s)
- Elizabeth A Manci
- Department of Pathology, University of South Alabama, Mobile, Alabama
| | - Kalsang Dolma
- Pediatric Division of Neonatology, University of South Alabama, Mobile, Alabama
| | - Chaitra Manjunath
- Pediatric Division of Neonatology, University of South Alabama, Mobile, Alabama
| | - Shou-Shawn Liu
- Department of Pathology, University of South Alabama, Mobile, Alabama
| | - Carlos A Galliani
- Department of Pathology, University of South Alabama, Mobile, Alabama
| | - Ramachandra Bhat
- Pediatric Division of Neonatology, University of South Alabama, Mobile, Alabama
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6
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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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7
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Fermo E, Vercellati C, Marcello AP, Keskin EY, Perrotta S, Zaninoni A, Brancaleoni V, Zanella A, Giannotta JA, Barcellini W, Bianchi P. Targeted Next Generation Sequencing and Diagnosis of Congenital Hemolytic Anemias: A Three Years Experience Monocentric Study. Front Physiol 2021; 12:684569. [PMID: 34093240 PMCID: PMC8176228 DOI: 10.3389/fphys.2021.684569] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 03/23/2021] [Accepted: 04/27/2021] [Indexed: 01/01/2023] Open
Abstract
Congenital hemolytic anemias (CHAs) are heterogeneous and rare disorders caused by alterations in structure, membrane transport, metabolism, or red blood cell production. The pathophysiology of these diseases, in particular the rarest, is often poorly understood, and easy-to-apply tools for diagnosis, clinical management, and patient stratification are still lacking. We report the 3-years monocentric experience with a 43 genes targeted Next Generation Sequencing (t-NGS) panel in diagnosis of CHAs; 122 patients from 105 unrelated families were investigated and the results compared with conventional laboratory pathway. Patients were divided in two groups: 1) cases diagnosed with hematologic investigations to be confirmed at molecular level, and 2) patients with unexplained anemia after extensive hematologic investigation. The overall sensitivity of t-NGS was 74 and 35% for families of groups 1 and 2, respectively. Inside this cohort of patients we identified 26 new pathogenic variants confirmed by functional evidence. The implementation of laboratory work-up with t-NGS increased the number of diagnoses in cases with unexplained anemia; cytoskeleton defects are well detected by conventional tools, deserving t-NGS to atypical cases; the diagnosis of Gardos channelopathy, some enzyme deficiencies, familial siterosterolemia, X-linked defects in females and other rare and ultra-rare diseases definitely benefits of t-NGS approaches.
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Affiliation(s)
- Elisa Fermo
- UOS Fisiopatologia delle Anemie, UOC Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Cristina Vercellati
- UOS Fisiopatologia delle Anemie, UOC Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Paola Marcello
- UOS Fisiopatologia delle Anemie, UOC Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ebru Yilmaz Keskin
- Department of Pediatric Hematology and Oncology, Suleyman Demirel University, Isparta, Turkey
| | - Silverio Perrotta
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli Studi della Campania "Luigi Vanvitelli," Naples, Italy
| | - Anna Zaninoni
- UOS Fisiopatologia delle Anemie, UOC Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Valentina Brancaleoni
- UOC Medicina Generale, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Zanella
- UOS Fisiopatologia delle Anemie, UOC Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Juri A Giannotta
- UOS Fisiopatologia delle Anemie, UOC Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Wilma Barcellini
- UOS Fisiopatologia delle Anemie, UOC Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Bianchi
- UOS Fisiopatologia delle Anemie, UOC Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Kim DS, Baek HJ, Kim BR, Yoon BA, Lee JH, Kook H. The First Korean Family with Hemoglobin-M Milwaukee-2 Leading to Hereditary Methemoglobinemia. Yonsei Med J 2020; 61:1064-1067. [PMID: 33251782 PMCID: PMC7700874 DOI: 10.3349/ymj.2020.61.12.1064] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/08/2020] [Indexed: 11/27/2022] Open
Abstract
Hemoglobin M (HbM) is a group of abnormal hemoglobin variants that form methemoglobin, which leads to cyanosis and hemolytic anemia. HbM-Milwaukee-2 is a rare variant caused by the point mutation CAC>TAC on codon 93 of the hemoglobin subunit beta (HBB) gene, resulting in the replacement of histidine by tyrosine. We here report the first Korean family with HbM-Milwaukee-2, whose diagnosis was confirmed by gene sequencing. A high index of suspicion for this rare Hb variant is necessary in a patient presenting with cyanosis since childhood, along with methemoglobinemia and a family history of cyanosis.
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Affiliation(s)
- Dae Sung Kim
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Hee Jo Baek
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Hwasun, Korea
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Korea.
| | - Bo Ram Kim
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Bo Ae Yoon
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Hwasun, Korea
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Korea
| | - Jun Hyung Lee
- Department of Laboratory Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Hoon Kook
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Hwasun, Korea
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Korea
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9
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Someya M, Sasahara J, Yamamoto S, Sawada A, Nishikawa M, Ishii K. Prenatally diagnosed congenital hemangioma with elevated middle cerebral artery peak systolic velocity mimicking the Kasabach-Merritt phenomenon: A case report. J Obstet Gynaecol Res 2019; 45:2456-2460. [PMID: 31502338 DOI: 10.1111/jog.14121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 03/26/2019] [Accepted: 08/25/2019] [Indexed: 12/13/2022]
Abstract
Congenital hemangioma is a rare vascular tumor that develops prenatally, and a large congenital hemangioma may be accompanied by the Kasabach-Merritt phenomenon. We present a case of prenatally diagnosed fetal congenital hemangioma through ultrasound and maternal anti-Jr(a) antibody alloimmunization with elevated middle cerebral artery peak systolic velocity. To investigate fetal anemia and hemostatic condition, we performed percutaneous umbilical blood sampling, which revealed no symptom of either Kasabach-Merritt phenomenon or sensitization to anti-Jr(a) antibody. Consequently, pregnancy could be continued without further intervention. After birth, congenital hemangioma was found on the infant's left thigh, and Kasabach-Merritt phenomenon was not shown. Percutaneous umbilical blood sampling could provide precise information prenatally in case of congenital hemangioma with maternal alloimmunization.
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Affiliation(s)
- Masayuki Someya
- Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Jun Sasahara
- Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Satoshi Yamamoto
- Department of Neonatology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Akihisa Sawada
- Department of Hematology/Oncology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Masanori Nishikawa
- Department of Radiology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Keisuke Ishii
- Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
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10
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Khurana M, Edwards D, Rescorla F, Miller C, He Y, Sierra Potchanant E, Nalepa G. Whole-exome sequencing enables correct diagnosis and surgical management of rare inherited childhood anemia. Cold Spring Harb Mol Case Stud 2018; 4:mcs.a003152. [PMID: 30275003 PMCID: PMC6169821 DOI: 10.1101/mcs.a003152] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/07/2018] [Indexed: 12/31/2022] Open
Abstract
Correct diagnosis of inherited bone marrow failure syndromes is a challenge because of the significant overlap in clinical presentation of these disorders. Establishing right genetic diagnosis is crucial for patients’ optimal clinical management and family counseling. A nondysmorphic infant reported here developed severe transfusion-dependent anemia and met clinical criteria for diagnosis of Diamond–Blackfan anemia (DBA). However, whole-exome sequencing demonstrated that the child was a compound heterozygote for a paternally inherited pathogenic truncating variant (SPTA1c.4975 C>T) and a novel maternally inherited missense variant of uncertain significance (SPTA1c.5029 G>A) within the spectrin gene, consistent with hereditary hemolytic anemia due to disruption of red blood cell (RBC) cytoskeleton. Ektacytometry demonstrated abnormal membrane flexibility of the child's RBCs. Scanning electron microscopy revealed morphological aberrations of the patient's RBCs. Both parents were found to have mild hereditary elliptocytosis. Importantly, patients with severe RBC membrane defects may be successfully managed with splenectomy to minimize peripheral destruction of misshapen RBCs, whereas patients with DBA require lifelong transfusions, steroid therapy, or hematopoietic stem cell transplantation. As suggested by the WES findings, splenectomy rendered our patient transfusion-independent, improving the family's quality of life and preventing transfusion-related iron overload. This case illustrates the utility of whole-exome sequencing in clinical care of children with genetic disorders of unclear presentation.
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Affiliation(s)
- Monica Khurana
- Riley Hospital for Children at IU Health, Indianapolis, Indiana 46202, USA.,Division of Pediatric Hematology-Oncology, Department of Pediatrics, IU School of Medicine, Indianapolis, Indiana 46202, USA
| | - Donna Edwards
- Riley Hospital for Children at IU Health, Indianapolis, Indiana 46202, USA.,Division of Pediatric Hematology-Oncology, Department of Pediatrics, IU School of Medicine, Indianapolis, Indiana 46202, USA.,Wells Center for Pediatric Research, IU School of Medicine, Indianapolis, Indiana 46202, USA
| | - Frederic Rescorla
- Department of Surgery, IU School of Medicine, Indianapolis, Indiana 46202, USA
| | - Caroline Miller
- Electron Microscopy Core, IU School of Medicine, Indianapolis, Indiana 46202, USA
| | - Ying He
- Wells Center for Pediatric Research, IU School of Medicine, Indianapolis, Indiana 46202, USA
| | | | - Grzegorz Nalepa
- Riley Hospital for Children at IU Health, Indianapolis, Indiana 46202, USA.,Division of Pediatric Hematology-Oncology, Department of Pediatrics, IU School of Medicine, Indianapolis, Indiana 46202, USA.,Wells Center for Pediatric Research, IU School of Medicine, Indianapolis, Indiana 46202, USA.,Department of Biochemistry, IU School of Medicine, Indianapolis, Indiana 46202, USA.,Department of Medical and Molecular Genetics, IU School of Medicine, Indianapolis, Indiana 46202, USA
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Pedroso GA, Kimura EM, Santos MNN, Albuquerque DM, Ferruzzi JLH, Jorge SE, Costa FF, Saad STO, Sonati MF. Coinheritance of Hb Bristol-Alesha [β67(E11)Val→Met; HBB: c.202G>A] and the α212 Patchwork Allele in a Brazilian Child with Severe Congenital Hemolytic Anemia. Hemoglobin 2017; 41:203-208. [PMID: 28670945 DOI: 10.1080/03630269.2017.1340305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Hb Bristol-Alesha [HBB: c.202G>A; β 67 Val>Met] is a rare structural variant of hemoglobin (Hb) resulting from a GTG>ATG substitution at codon 67 of the β-globin gene that leads to the replacement of valine by methionine in the corresponding position of the β-globin chain. The methionine residue is subsequently modified to aspartic acid [β67(E11)Val-Met→Asp], possibly by autoxidation mechanisms. This substitution prevents normal non-polar binding of Val67 to the heme group, resulting in molecular instability and severe hemolysis. We identified Hb Bristol-Alesha (in the heterozygous state), as the cause of severe congenital hemolytic anemia in an 11-month-old girl of mixed (native Indian and European) ethnic origin from the Midwestern region of Brazil, whose parents were clinically and hematologically normal. The mutation on the β-globin gene was found to have been coinherited with the α212 patchwork allele.
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Affiliation(s)
- Gisele A Pedroso
- a Hemoglobinopathies Laboratory, Department of Clinical Pathology , School of Medical Sciences, State University of Campinas (UNICAMP), Campinas , São Paulo , Brazil
| | - Elza M Kimura
- a Hemoglobinopathies Laboratory, Department of Clinical Pathology , School of Medical Sciences, State University of Campinas (UNICAMP), Campinas , São Paulo , Brazil
| | - Magnun N N Santos
- a Hemoglobinopathies Laboratory, Department of Clinical Pathology , School of Medical Sciences, State University of Campinas (UNICAMP), Campinas , São Paulo , Brazil
| | - Dulcinéia M Albuquerque
- b Hematology and Hemotherapy Center, State University of Campinas (UNICAMP), Campinas , São Paulo , Brazil
| | - Jucilane L H Ferruzzi
- c University Hospital, Federal University of Grande Dourados (UFGD), Dourados , Mato Grosso do Sul , Brazil
| | - Susan E Jorge
- a Hemoglobinopathies Laboratory, Department of Clinical Pathology , School of Medical Sciences, State University of Campinas (UNICAMP), Campinas , São Paulo , Brazil
| | - Fernando F Costa
- b Hematology and Hemotherapy Center, State University of Campinas (UNICAMP), Campinas , São Paulo , Brazil
| | - Sara T O Saad
- b Hematology and Hemotherapy Center, State University of Campinas (UNICAMP), Campinas , São Paulo , Brazil
| | - Maria F Sonati
- a Hemoglobinopathies Laboratory, Department of Clinical Pathology , School of Medical Sciences, State University of Campinas (UNICAMP), Campinas , São Paulo , Brazil
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Lacy JN, Ulirsch JC, Grace RF, Towne MC, Hale J, Mohandas N, Lux SE, Agrawal PB, Sankaran VG. Exome sequencing results in successful diagnosis and treatment of a severe congenital anemia. Cold Spring Harb Mol Case Stud 2016; 2:a000885. [PMID: 27551681 PMCID: PMC4990811 DOI: 10.1101/mcs.a000885] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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] [Indexed: 01/05/2023] Open
Abstract
Whole-exome sequencing is increasingly used for diagnosis and identification of appropriate therapies in patients. Here, we present the case of a 3-yr-old male with a lifelong and severe transfusion-dependent anemia of unclear etiology, despite an extensive clinical workup. Given the difficulty of making the diagnosis and the potential side effects from performing interventions in patients with a congenital anemia of unknown etiology, we opted to perform whole-exome sequencing on the patient and his parents. This resulted in the identification of homozygous loss-of-function mutations in the EPB41 gene, encoding erythrocyte protein band 4.1, which therefore causes a rare and severe form of hereditary elliptocytosis in the patient. Based on prior clinical experience in similar patients, a surgical splenectomy was performed that resulted in subsequent transfusion independence in the patient. This case illustrates how whole-exome sequencing can lead to accurate diagnoses (and exclusion of diagnoses where interventions, such as splenectomy, would be contraindicated), thereby resulting in appropriate and successful therapeutic intervention—a major goal of precision medicine.
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Affiliation(s)
- Jessica N Lacy
- Division of Hematology/Oncology, The Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA;; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts 02115, USA;; Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
| | - Jacob C Ulirsch
- Division of Hematology/Oncology, The Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA;; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts 02115, USA;; Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
| | - Rachael F Grace
- Division of Hematology/Oncology, The Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA;; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Meghan C Towne
- Division of Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - John Hale
- New York Blood Center, New York, New York 10065, USA
| | | | - Samuel E Lux
- Division of Hematology/Oncology, The Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA;; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Pankaj B Agrawal
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA;; Division of Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA;; Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Vijay G Sankaran
- Division of Hematology/Oncology, The Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA;; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts 02115, USA;; Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
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13
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Hansen DL, Overgaard UM, Pedersen L, Frederiksen H. Positive predictive value of diagnosis coding for hemolytic anemias in the Danish National Patient Register. Clin Epidemiol 2016; 8:241-52. [PMID: 27445504 PMCID: PMC4928658 DOI: 10.2147/clep.s93643] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose The nationwide public health registers in Denmark provide a unique opportunity for evaluation of disease-associated morbidity if the positive predictive values (PPVs) of the primary diagnosis are known. The aim of this study was to evaluate the predictive values of hemolytic anemias registered in the Danish National Patient Register. Patients and methods All patients with a first-ever diagnosis of hemolytic anemia from either specialist outpatient clinic contact or inpatient admission at Odense University Hospital from January 1994 through December 2011 were considered for inclusion. Patients with mechanical reason for hemolysis such as an artificial heart valve, and patients with vitamin-B12 or folic acid deficiency were excluded. Results We identified 412 eligible patients: 249 with a congenital hemolytic anemia diagnosis and 163 with acquired hemolytic anemia diagnosis. In all, hemolysis was confirmed in 359 patients, yielding an overall PPV of 87.1% (95% confidence interval [CI]: 83.5%–90.2%). A diagnosis could be established in 392 patients of whom 355 patients had a hemolytic diagnosis. Diagnosis was confirmed in 197 of the 249 patients with congenital hemolytic anemia, yielding a PPV of 79.1% (95% CI: 73.5%–84.0%). Diagnosis of acquired hemolytic anemia could be confirmed in 136 of the 163 patients, resulting in a PPV of 83.4% (95% CI: 76.8%–88.8%). For hemoglobinopathy PPV was 84.1% (95% CI: 77.4%–89.4%), for hereditary spherocytosis PPV was 80.6% (95% CI: 69.5%–88.9%), and for autoimmune hemolytic anemia PPV was 78.4% (95% CI: 70.4%–85.0%). Conclusion The PPV of hemolytic anemias was moderately high. The PPVs were comparable in the three main categories of overall hemolysis, and congenital and acquired hemolytic anemia.
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Affiliation(s)
| | | | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Frederiksen
- Department of Haematology, Odense University Hospital, Odense; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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El Agheb MOM, Grange JD. [Evaluation of tolerance and efficacy of the treatment of chronic viral hepatitis C in homozygous sickle cell patients]. Pan Afr Med J 2015. [PMID: 26213600 PMCID: PMC4506797 DOI: 10.11604/pamj.2015.20.99.6003] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 12/02/2022] Open
Abstract
La drépanocytose est une maladie génétique à transmission autosomale codominante. Les patients homozygotes ont des crises hémolytiques qui génèrent les symptômes cliniques. Il s'agit d'une maladie fréquente. En France, la plupart des cas hospitalisés sont observés en Ile de France et aux Antilles. Le pronostic des patients s'est beaucoup amélioré ces dernières années. L’âge médian au décès a doublé en 20 ans. Il est passé de 18 à 36 ans, témoignant d'une meilleure prise en charge des malades. De ce fait, les complications hépatiques de la maladie, et notamment celles liées à l'hépatite virale chronique C, sont de plus en plus fréquentes. La Ribavirine étant contre indiquée dans le traitement de l'hépatite C chez les malades atteints d'anémie hémolytique (talassémie, drépanocytose), il n'existe que très peu de cas publiés dans les littératures et aucun cas traité par trithérapie antivirale incluant un inhibiteur de protéase. Le but de ce travail était d’évaluer la tolérance, l'efficacité du traitement de l'hépatite virale chronique C chez des patients drépanocytaires homozygotes. Dans la cohorte de patients drépanocytaires homozygotes adultes de l'hôpital Tenon (n = 560), la prévalence de l'hépatite C chez les derepanocytaires était de 7% (n = 38) en 2012. Il s'agissait de 15 hommes et 23 femmes âgés de 20 à 59 ans. Vingt-cinq patients avaient reçu plus de 10 transfusions et 13 patients avaient reçu moins de 10 transfusions au cours des années précédant le bilan. La répartition des génotypes était: G1 (n = 7); G2 (n = 2); G3 (n = 1); G4 (n = 6); G inconnu (n = 22). Neuf patients ont été traités dont 8 par bithérapie (Peg/Rbv) et 1 par trithérapie (télaprevir). La posologie de ribavirine était supérieure ou égale à 800mg/jour chez 7 patients et inférieure à cette dose chez les deux autres patients. Le score METAVIR de fibrose était: F1 (n = 3), F2 (n = 4) et F 3 (n = 1);un patient n'a pas pu etre biopsié. Aucun patient n'a présenté de crise vaso-occlusive. Un seul patient a du être transfusé. Chez les 8 autres patients, la tolérance hématologique était excellente; le taux d'hémoglobine moyen était supérieur au taux moyen pré-thérapeutique après 1 et 3 mois de traitement. Une réponse virologique complète était observée chez tous les patients en fin de traitement et une réponse virale soutenue (SVR 24) était obtenue chez 6 patients. La cohorte des patients atteints de drépanocytose de l'Hôpital Tenon est une des plus importantes décrites dans la littérature. La prévalence de l'infection par le virus C est de 7% chez les patients homozygotes SS faisant des crises vaso occlusive. Cette série confirme que la prévalence dépend du nombre de transfusions (supérieures ou inférieures à 10 unités d’érythrocytes) avant le diagnostic. Il confirme également la bonne tolérance de la prise de ribavirine chez ces patients ayant une anémie hémolytique congénitale. Aucune crise vaso-occlusive n'a été observée. Le nombre de transfusion n'est pas augmenté. La bonne tolérance également observée chez le malade traité par trithérapie peut ouvrir la voie à l’évaluation des nouveaux antiviraux directs. Un suivi régulier conjoint par un hépatologue et un hématologue est impératif dans cette population fragile.
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Affiliation(s)
| | - Jean-Didier Grange
- Service d'Hépato Gastro Enterologie Hôpital Tenon, 4 Rue de La Chine, 75020 Paris
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Aissa K, Kamoun F, Sfaihi L, Ghedira ES, Aloulou H, Kamoun T, Pissard S, Hachicha M. Hemolytic anemia and progressive neurologic impairment: think about triosephosphate isomerase deficiency. Fetal Pediatr Pathol 2014; 33:234-8. [PMID: 24840153 DOI: 10.3109/15513815.2014.915365] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 11/13/2022]
Abstract
We have reported the first Tunisian case of triosephosphate isomerase (TPI) deficiency in a 2-year-old girl. She was the first child of a nonconsanguineous couple. The disease included a neonatal onset of chronic hemolytic anemia, recurrent low-respiratory infections then progressive neurological involvement. The diagnosis was made after her death from the TPI values of her parents who exhibited intermediate enzyme deficiency. Molecular study of TPI genes showed that the father and the mother are heterozygous for Glu105Asp mutation. Pediatricians must be alert to the differential diagnosis in patients having hemolytic anemia and other concomitant manifestations.
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Affiliation(s)
- Khaoula Aissa
- 1Faculté de médecine de Tunis, Université Tunis Elmanar. Hôpital Mohamed Tlatli de Nabeul, pediatrics, Nabeul, Tunisia
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Watanabe T, Ono H, Tajima I, Ishigaki H, Hakamata A, Shirai M, Endoh A, Hongo T. Hereditary spherocytosis diagnosed with the eosin-5'-maleimide binding test. Pediatr Int 2014; 56:427-9. [PMID: 24894931 DOI: 10.1111/ped.12293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Received: 03/06/2013] [Revised: 10/10/2013] [Accepted: 12/17/2013] [Indexed: 11/28/2022]
Abstract
We describe three cases of hereditary spherocytosis (HS) diagnosed using the eosin-5'-maleimide (EMA) binding test and discuss the relevance of the EMA binding test. In Japan, this test is not widely used because the prevalence of HS is low. This test is a valuable screening test for the diagnosis of HS.
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Affiliation(s)
- Toru Watanabe
- Department of Pediatrics, Iwata City Hospital, Iwata, Japan
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