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Yang K, Liu X, Chen K, Luo S, Kong W, Huang W, Xiao J. A case of G6PD Utrecht associated with β-thalassemia responding to splenectomy. Pediatr Blood Cancer 2022; 69:e29837. [PMID: 35695473 DOI: 10.1002/pbc.29837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/23/2022] [Accepted: 05/23/2022] [Indexed: 11/07/2022]
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked genetic disease caused by a pathogenic G6PD mutation. An 8-year-old Chinese male child was investigated because of chronic nonspherocytic hemolytic anemia (CNSHA) associated with hepatosplenomegaly. Genetic analysis unraveled co-inheritance of a hemizygous mutation c.1225C>T (p.Pro409Ser) in G6PD (G6PD Utrecht, previously reported only in The Netherlands) and heterozygote HBB mutation c.316-197C>T (IVS-Ⅱ-654 C>T). Because IVS-Ⅱ-654 C>T on its own does not cause CNSHA, we believe that the clinical manifestations in this patient are essentially due to the G6PD c.1225C>T mutation. The boy gained transfusion independence after splenectomy.
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Affiliation(s)
- Kun Yang
- Department of Hematology, Zigong First People's Hospital, Zigong, China
| | - Xiaodong Liu
- Department of Hematology, Zigong First People's Hospital, Zigong, China
| | - Kai Chen
- Department of Critical Medicine, Zigong First People's Hospital, Zigong, China
| | - Shan Luo
- Department of Hematology, Zigong First People's Hospital, Zigong, China
| | - Wenqiang Kong
- Department of Pharmacy, Zigong First People's Hospital, Zigong, China
| | - Wenying Huang
- Department of Hematology, Zigong First People's Hospital, Zigong, China
| | - Jian Xiao
- Department of Hematology, Zigong First People's Hospital, Zigong, China
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DelFavero JJ, Jnah AJ, Newberry D. Glucose-6-Phosphate Dehydrogenase Deficiency and the Benefits of Early Screening. Neonatal Netw 2021; 39:270-282. [PMID: 32879043 DOI: 10.1891/0730-0832.39.5.270] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2020] [Indexed: 11/25/2022]
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) deficiency, the most common enzymopathy worldwide, is an insufficient amount of the G6PD enzyme, which is vital to the protection of the erythrocyte. Deficient enzyme levels lead to oxidative damage, hemolysis, and resultant severe hyperbilirubinemia. If not promptly recognized and treated, G6PD deficiency can potentially lead to bilirubin-induced neurologic dysfunction, acute bilirubin encephalopathy, and kernicterus. Glucose-6-phosphate dehydrogenase deficiency is one of the three most common causes for pathologic hyperbilirubinemia. A change in migration patterns and intercultural marriages have created an increased incidence of G6PD deficiency in the United States. Currently, there is no universally mandated metabolic screening or clinical risk assessment tool for G6PD deficiency in the United States. Mandatory universal screening for G6PD deficiency, which includes surveillance and hospital-based risk assessment tools, can identify the at-risk infant and foster early identification, diagnosis, and treatment to eliminate neurotoxicity.
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Abstract
Mature red blood cells are reliant on the glycolytic pathway for energy production and the hexose monophosphate shunt for cell protection from oxidative insults. The most common red blood cell enzyme disorders are characterized by hemolysis but with wide clinical variability. Glucose-6-phosphate dehydrogenase deficiency is the most common red cell enzyme disorder worldwide. Frequent clinical presentations include neonatal jaundice and episodic hemolysis after exposure to oxidative stress. Symptoms of pyruvate kinase deficiency and other glycolytic enzyme disorders include neonatal jaundice, chronic hemolytic anemia, gallstones, and transfusion-related and transfusion-independent iron overload. Diagnosis is critical for appropriate supportive care, monitoring, and treatment.
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Affiliation(s)
- Rachael F Grace
- Department of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, 450 Brookline Avenue, Dana 3-106, Boston, MA 02215, USA.
| | - Bertil Glader
- Department of Pediatric Hematology/Oncology, Lucile Packard Children's Hospital, Stanford University School of Medicine, 1000 Welch Road # 300, Palo Alto, CA 94304, USA
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Iolascon A, Andolfo I, Barcellini W, Corcione F, Garçon L, De Franceschi L, Pignata C, Graziadei G, Pospisilova D, Rees DC, de Montalembert M, Rivella S, Gambale A, Russo R, Ribeiro L, Vives-Corrons J, Martinez PA, Kattamis A, Gulbis B, Cappellini MD, Roberts I, Tamary H. Recommendations regarding splenectomy in hereditary hemolytic anemias. Haematologica 2017; 102:1304-1313. [PMID: 28550188 PMCID: PMC5541865 DOI: 10.3324/haematol.2016.161166] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 05/22/2017] [Indexed: 01/19/2023] Open
Abstract
Hereditary hemolytic anemias are a group of disorders with a variety of causes, including red cell membrane defects, red blood cell enzyme disorders, congenital dyserythropoietic anemias, thalassemia syndromes and hemoglobinopathies. As damaged red blood cells passing through the red pulp of the spleen are removed by splenic macrophages, splenectomy is one possible therapeutic approach to the management of severely affected patients. However, except for hereditary spherocytosis for which the effectiveness of splenectomy has been well documented, the efficacy of splenectomy in other anemias within this group has yet to be determined and there are concerns regarding short- and long-term infectious and thrombotic complications. In light of the priorities identified by the European Hematology Association Roadmap we generated specific recommendations for each disorder, except thalassemia syndromes for which there are other, recent guidelines. Our recommendations are intended to enable clinicians to achieve better informed decisions on disease management by splenectomy, on the type of splenectomy and the possible consequences. As no randomized clinical trials, case control or cohort studies regarding splenectomy in these disorders were found in the literature, recommendations for each disease were based on expert opinion and were subsequently critically revised and modified by the Splenectomy in Rare Anemias Study Group, which includes hematologists caring for both adults and children.
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Affiliation(s)
- Achille Iolascon
- Department of Molecular Medicine and Medical Biotechnology, University Federico II Naples, Italy .,CEINGE Biotecnologie Avanzate, Naples, Italy
| | - Immacolata Andolfo
- Department of Molecular Medicine and Medical Biotechnology, University Federico II Naples, Italy.,CEINGE Biotecnologie Avanzate, Naples, Italy
| | - Wilma Barcellini
- Oncohematology Unit, IRCCS Ca' Granda Foundation, Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Corcione
- Department of General Surgery, Monaldi Hospital A.O.R.N. dei Colli, Naples, Italy
| | - Loïc Garçon
- Service d'Hématologie Biologique, CHU Amiens Picardie, Amiens, France
| | | | - Claudio Pignata
- Department of Translational Medical Sciences, Federico II University of Naples, Italy
| | - Giovanna Graziadei
- Department of Clinical Science and Community Health, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Dagmar Pospisilova
- Department of Pediatrics, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - David C Rees
- Department of Paediatric Haematology, King's College Hospital, King's College London School of Medicine, UK
| | | | - Stefano Rivella
- Department of Pediatrics, Division of Hematology-Oncology, Children's Blood and Cancer Foundation Laboratories, Weill Cornell Medical College, New York, NY, USA; Department of Pediatrics, Division of Hematology, Children's Hospital of Philadelphia, PA, USA
| | - Antonella Gambale
- Department of Molecular Medicine and Medical Biotechnology, University Federico II Naples, Italy.,CEINGE Biotecnologie Avanzate, Naples, Italy
| | - Roberta Russo
- Department of Molecular Medicine and Medical Biotechnology, University Federico II Naples, Italy.,CEINGE Biotecnologie Avanzate, Naples, Italy
| | - Leticia Ribeiro
- Hematology Service, Hospital and University Center of Coimbra (CHUC), Portugal
| | | | | | | | - Beatrice Gulbis
- Department of Clinical Chemistry, Hôpital Erasme, U.L.B., Brussels, Belgium
| | - Maria Domenica Cappellini
- Department of Clinical Science and Community Health, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Irene Roberts
- Department of Paediatrics, Children's Hospital, University of Oxford, John Radcliffe Hospital, UK
| | - Hannah Tamary
- Pediatric Hematology Unit, Schneider Children's Medical Center of Israel, Petah Tiqva, Sackler Faculty of Medicine, Tel Aviv University, Israel
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Wadowski B, Chang D, Khan SQ, Chadha T. Sometimes, It's Just Black and White: Dark Urine and Pallor in a 2-Year-Old Boy. Hosp Pediatr 2016; 6:560-5. [PMID: 27554269 DOI: 10.1542/hpeds.2015-0252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Denis Chang
- New York University Langone Medical Center, New York, New York
| | - Sabina Q Khan
- New York University Langone Medical Center, New York, New York
| | - Tanya Chadha
- New York University School of Medicine, New York, New York; and Division of Pediatric Critical Care,
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Lau YZ, Lau YF, Lai KY, Lau CP. Splenic artery pseudoaneurysm due to seatbelt injury in a glucose-6-phosphate dehydrogenase-deficient adult. Singapore Med J 2013; 54:e230-2. [PMID: 24276111 DOI: 10.11622/smedj.2013189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 23-year-old man presented with abdominal pain after suffering blunt trauma caused by a seatbelt injury. His low platelet count of 137 × 10(9)/L was initially attributed to trauma and his underlying hypersplenism due to glucose-6-phosphate dehydrogenase (G6PD) deficiency. Despite conservative management, his platelet count remained persistently reduced even after his haemoglobin and clotting abnormalities were stabilised. After a week, follow-up imaging revealed an incidental finding of a pseudoaneurysm (measuring 9 mm × 8 mm × 10 mm) adjacent to a splenic laceration. The pseudoaneurysm was successfully closed via transcatheter glue embolisation; 20% of the spleen was also embolised. A week later, the platelet count normalised, and the patient was subsequently discharged. This case highlights the pitfalls in the detection of a delayed occurrence of splenic artery pseudoaneurysm after blunt injury via routine delayed phase computed tomography. While splenomegaly in G6PD may be a predisposing factor for injury, a low platelet count should arouse suspicion of internal haemorrhage rather than hypersplenism.
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Affiliation(s)
- Yu Zhen Lau
- Cardiac Heart Health Centre, Suite 1303, Central Building, 3 Pedder Street, Central, Hong Kong, China.
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Wiwanitkit V. Comparison for functional aberration of G-6-PD deficiency variants with exon 10 mutations. ACTA ACUST UNITED AC 2005; 10:261-3. [PMID: 16019475 DOI: 10.1080/10245330500065813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Glucose-6-phosphate dehydrogenase (G-6-PD) deficiency is a common inherited enzyme deficiency in many parts of the world and there are many different variants described. Every G-6-PD deficiency variant has a unique underlying genetic defect, therefore it manifests specific properties. The single amino acid substitution in the globin chain is the commonest form of G-6-PD deficiency variant. Usually, the G-6-PD deficiency variant with the pathogenesis of a single amino acid substitution presents with only one aberration in secondary structure. Although many G-6-PD deficiency variants present similar structural abnormal points their functions sometimes are discordant. Here, the author performed a functional analysis on some alpha haemoglobinopathies using a novel bioinformatic tool, Polyphen. The mutations of five G-6-PD deficiency variants with exon 10 mutations, Guadalajara (386 Arg-->Cys), Beverly Hills (387 Arg-->His), Serres (361 Ala-->Val), Iowa (385 Lys-->Glu), and Clinic (405 Met-->Ile) were selected for further study in this investigation. According to the in silico mutation study, the functional change in the G-6-PD deficiency variants with exon 10 mutations studied is variable. Here, it indicates that the functional aberration in the G-6-PD deficiency variant is based on complex pathogenesis. The identification of the structural aberration only in a G-6-PD deficiency variant is not sufficient and should be supplemented with a further functional analysis for a better insight in this topic.
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Affiliation(s)
- Viroj Wiwanitkit
- Department of Laboratory Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
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