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Villarreal-Martínez L, Torres-Sánchez KA, Ibarra-Ramírez M, Martínez-Garza LE, Villarreal-Martínez DZ, Viera DAG, Herrera MDCR, O-Castillo M, Bautista-Gómez AJ, Martínez AG, de la Garza JFM. Prevalence of Glucose-6-Phosphate Dehydrogenase Deficiency in Newborns in Northeast Mexico. Am J Perinatol 2024; 41:e573-e576. [PMID: 35977713 DOI: 10.1055/a-1926-0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Glucose-6-phosphate dehydrogenase deficiency (G6PDd) is the most common enzymatic disease worldwide and the prevalence is not well established because of the lack of screening. This study aimed to estimate the prevalence of G6PDd in a Hispanic population from Northeast Mexico. STUDY DESIGN In this retrospective study, a database was used to analyze the G6PDd in neonates included in the expanded newborn metabolic screening of inherited metabolic disorders during a period of 4 years through the GSP Neonatal G6 kit (PerkinElmer). RESULTS Among 96,152 (48,462 male) neonates screened for G6PD enzyme activity, a total of 566 (0.58%) cases were deficient for G6PD. Of those 566 patients, 469 (82.8%) attended the second test and the other 97 (17.2%) patients were lost. Of those 469 who did attend, 384 (81.9%) neonates were deficient in the second test and 85 (18.1%) were normal. With the data collected, 384 neonates were confirmed with G6PDd, 348 (88.6%) were male and 36 (11.4%) patients were female. The calculated prevalence for this population was 0.72 cases per 100 male newborns. CONCLUSION The prevalence of G6PDd in the Northeastern Mexican population is high. Since migration is increasing in the United States, pediatricians should be aware of the need to search for G6PDd in newborns and the wide clinical manifestations they can present. KEY POINTS · The calculated prevalence of glucose-6-phosphate dehydrogenase deficiency in Northeast Mexico is 3.99 cases per 1,000 newborns.. · Glucose-6-phosphate dehydrogenase deficiency screenings should be included in all newborn metabolic screenings.. · Glucose-6-phosphate dehydrogenase deficiency is a common erythroenzymopathy that must be addressed as a public health concern. To anticipate clinical complications, target population monitoring is required..
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Affiliation(s)
- Laura Villarreal-Martínez
- Hematology Department, Hospital Universitario ̈Dr. José Eleuterio González̈ Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Katia A Torres-Sánchez
- Hematology Department, Hospital Universitario ̈Dr. José Eleuterio González̈ Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Marisol Ibarra-Ramírez
- Genetics Department, Hospital Universitario ̈Dr. José Eleuterio González̈ Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Laura E Martínez-Garza
- Genetics Department, Hospital Universitario ̈Dr. José Eleuterio González̈ Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Daniel Z Villarreal-Martínez
- Hematology Department, Hospital Universitario ̈Dr. José Eleuterio González̈ Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Daniel A G Viera
- Hematology Department, Hospital Universitario ̈Dr. José Eleuterio González̈ Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - María Del C R Herrera
- Genetics Department, Hospital Universitario ̈Dr. José Eleuterio González̈ Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Miguel O-Castillo
- Hematology Department, Hospital Universitario ̈Dr. José Eleuterio González̈ Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Andrea J Bautista-Gómez
- Hematology Department, Hospital Universitario ̈Dr. José Eleuterio González̈ Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Adrián G Martínez
- Hematology Department, Hospital Universitario ̈Dr. José Eleuterio González̈ Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Juan F M de la Garza
- Hematology Department, Hospital Universitario ̈Dr. José Eleuterio González̈ Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
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Li H, Ch'ih Y, Li M, Luo Y, Liu H, Xu J, Song W, Ma Q, Shao Z. Newborn screening for G6PD deficiency in HeFei, FuYang and AnQing, China: Prevalence, cut-off value, variant spectrum. J Med Biochem 2024; 43:86-96. [PMID: 38496015 PMCID: PMC10943458 DOI: 10.5937/jomb0-43078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/14/2023] [Indexed: 03/19/2024] Open
Abstract
Background Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked recessive Mendelian genetic disorder characterized by neonatal jaundice and hemolytic anemia, affecting more than 400 million people worldwide. The purpose of this research was to investigate prevalence rates of G6PD deficiency and to evaluate and establish specific cut-off values in early prediction of G6PD deficiency by regions (HeFei, FuYang, AnQing) on different seasons, as well as to investigate the frequencies of G6PD gene mutations among three regions mentioned above. Methods A total of 31,482 neonates (21,402, 7680, and 2340 for HeFei, FuYang, and AnQing cities, respectively) were recruited. Positive subjects were recalled to attend genetic tests for diagnosis. G6PD activity on the Genetic screening processor (GSP analyzer, 2021-0010) was measured following the manufactureržs protocol. The cut-off value was first set to 35 U/dL. The receiver operating characteristics (ROC) curve was employed to assess and compare the efficiency in predicting G6PD deficiency among HeFei, FuYang, and AnQing cities in different seasons.
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Affiliation(s)
- Hui Li
- HeFei Women and Children Medical Care Center, HeFei City, Anhui Province, China
| | - Yah Ch'ih
- Zhejiang Biosan Biochemical Technologies Co., Ltd, Hangzhou City, Zhejiang Province, China
| | - Meiling Li
- HeFei Women and Children Medical Care Center, HeFei City, Anhui Province, China
| | - Yulei Luo
- FuYang Maternal and Child Health Family Planning Service Center, FuYang City, Anhui Province, China
| | - Hao Liu
- AnQing Maternal and Child Health Family Planning Service Center, AnQing City, Anhui Province, China
| | - Junyang Xu
- HeFei Women and Children Medical Care Center, HeFei City, Anhui Province, China
| | - Wangsheng Song
- HeFei Women and Children Medical Care Center, HeFei City, Anhui Province, China
| | - Qingqing Ma
- HeFei Women and Children Medical Care Center, HeFei City, Anhui Province, China
| | - Ziyu Shao
- HeFei Women and Children Medical Care Center, HeFei City, Anhui Province, China
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3
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Alangari AS, El-Metwally AA, Alanazi A, Al Khateeb BF, Al Kadri HM, Alshdoukhi IF, Aldubikhi AI, Alruwaili M, Alshahrani A. Epidemiology of Glucose-6-Phosphate Dehydrogenase Deficiency in Arab Countries: Insights from a Systematic Review. J Clin Med 2023; 12:6648. [PMID: 37892786 PMCID: PMC10607133 DOI: 10.3390/jcm12206648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/15/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a common metabolic disorder affecting more than 400 million individuals worldwide. Being an X-linked disorder, the disease is more common among males than females. Various Arab countries estimated the prevalence of G6PD deficiency; however, findings from different countries have not been synthesized collectively. Hence, a systematic review was undertaken to synthesize the findings on the epidemiology of G6PD deficiency in all Arab countries. We performed an electronic systematic literature search based on the eligibility criteria using databases, including MEDLINE, Embase, and CINHAL. The studies included in the review were primary and original research studies assessing the prevalence or incidence, risk factors, or determinants of G6PD deficiency, and published in the English language in a peer-reviewed scientific journal between 2000 and 2022. The systematic review was carried out with the help of an updated PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. After the screening, 23 full texts were finalized for data extraction. The prevalence of G6PD deficiency ranged from 2 to 31% with a greater burden among high-risk populations like neonates with sickle cell anemia. The determinants included males, family history, consanguineous marriages, and geographic regions, which were all risk factors, except for body weight, which was a protective factor. The prevalence of G6PD deficiency varies across Arab countries, with a higher prevalence in males than females. Different regions of Arab countries need to revisit their screening and diagnostic guidelines to detect G6PD deficiency promptly and prevent unnecessary morbidity and mortality among their communities.
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Affiliation(s)
- Abdulaziz S. Alangari
- College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia
| | - Ashraf A. El-Metwally
- College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia
| | - Abdullah Alanazi
- College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia
| | - Badr F. Al Khateeb
- College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia
- Department of Family Medicine, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh 11426, Saudi Arabia
| | - Hanan M. Al Kadri
- College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia
- Department of Obstetrics and Gynecology, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh 11426, Saudi Arabia
| | - Ibtehaj F. Alshdoukhi
- King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia
- Department of Basic Sciences, College of Science and Health Professions, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
| | | | - Muzun Alruwaili
- College of Medical Sciences, North Border University, Arar 91431, Saudi Arabia
| | - Awad Alshahrani
- King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia
- Department of Medicine, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh 11426, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia
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Geck RC, Powell NR, Dunham MJ. Functional interpretation, cataloging, and analysis of 1,341 glucose-6-phosphate dehydrogenase variants. Am J Hum Genet 2023; 110:228-239. [PMID: 36681081 PMCID: PMC9943724 DOI: 10.1016/j.ajhg.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/03/2023] [Indexed: 01/22/2023] Open
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) deficiency affects over 500 million individuals who can experience anemia in response to oxidative stressors such as certain foods and drugs. Recently, the World Health Organization (WHO) called for revisiting G6PD variant classification as a priority to implement genetic medicine in low- and middle-income countries. Toward this goal, we sought to collect reports of G6PD variants and provide interpretations. We identified 1,341 G6PD variants in population and clinical databases. Using the ACMG standards and guidelines for the interpretation of sequence variants, we provided interpretations for 268 variants, including 186 variants that were not reported or of uncertain significance in ClinVar, bringing the total number of variants with non-conflicting interpretations to 400. For 414 variants with functional or clinical data, we analyzed associations between activity, stability, and current classification systems, including the new 2022 WHO classification. We corroborated known challenges with classification systems, including phenotypic variation, emphasizing the importance of comparing variant effects across individuals and studies. Biobank data made available by All of Us illustrate the benefit of large-scale sequencing and phenotyping by adding additional support connecting variants to G6PD-deficient anemia. By leveraging available data and interpretation guidelines, we created a repository for information on G6PD variants and nearly doubled the number of variants with clinical interpretations. These tools enable better interpretation of G6PD variants for the implementation of genetic medicine.
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Affiliation(s)
- Renee C Geck
- Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA
| | - Nicholas R Powell
- Division of Clinical Pharmacology, Department of Medicine, School of Medicine, Indiana University, Indianapolis, IN 46202, USA
| | - Maitreya J Dunham
- Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA.
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Bancone G, Gilder ME, Win E, Gornsawun G, Penpitchaporn P, Moo PK, Archasuksan L, Wai NS, Win S, Aung KK, Hashmi A, Hanboonkunupakarn B, Nosten F, Carrara VI, McGready R. Technical evaluation and usability of a quantitative G6PD POC test in cord blood: a mixed-methods study in a low-resource setting. BMJ Open 2022; 12:e066529. [PMID: 36523222 PMCID: PMC9748916 DOI: 10.1136/bmjopen-2022-066529] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES New point-of-care (POC) quantitative G6PD testing devices developed to provide safe radical cure for Plasmodium vivax malaria may be used to diagnose G6PD deficiency in newborns at risk of severe neonatal hyperbilirubinaemia, improving clinical care, and preventing related morbidity and mortality. METHODS We conducted a mixed-methods study analysing technical performance and usability of the 'STANDARD G6PD' Biosensor when used by trained midwives on cord blood samples at two rural clinics on the Thailand-Myanmar border. RESULTS In 307 cord blood samples, the Biosensor had a sensitivity of 1.000 (95% CI: 0.859 to 1.000) and a specificity of 0.993 (95% CI: 0.971 to 0.999) as compared with gold-standard spectrophotometry to diagnose G6PD-deficient newborns using a receiver operating characteristic (ROC) analysis-derived threshold of ≤4.8 IU/gHb. The Biosensor had a sensitivity of 0.727 (95% CI: 0.498 to 0.893) and specificity of 0.933 (95% CI: 0.876 to 0.969) for 30%-70% activity range in girls using ROC analysis-derived range of 4.9-9.9 IU/gHb. These thresholds allowed identification of all G6PD-deficient neonates and 80% of female neonates with intermediate phenotypes.Need of phototherapy treatment for neonatal hyperbilirubinaemia was higher in neonates with deficient and intermediate phenotypes as diagnosed by either reference spectrophotometry or Biosensor.Focus group discussions found high levels of learnability, willingness, satisfaction and suitability for the Biosensor in this setting. The staff valued the capacity of the Biosensor to identify newborns with G6PD deficiency early ('We can know that early, we can counsel the parents about the chances of their children getting jaundice') and at the POC, including in more rural settings ('Because we can know the right result of the G6PD deficiency in a short time, especially for the clinic which does not have a lab'). CONCLUSIONS The Biosensor is a suitable tool in this resource-constrained setting to identify newborns with abnormal G6PD phenotypes at increased risk of neonatal hyperbilirubinaemia.
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Affiliation(s)
- Germana Bancone
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Mary Ellen Gilder
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Elsie Win
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Gornpan Gornsawun
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Penporn Penpitchaporn
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Phaw Khu Moo
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Laypaw Archasuksan
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Nan San Wai
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Sylverine Win
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Ko Ko Aung
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Ahmar Hashmi
- Institute for Implementation Science, University of Texas Health Sciences Center (UTHealth), Houston, Texas, USA
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Sciences Center (UTHealth), Houston, Texas, USA
| | - Borimas Hanboonkunupakarn
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Francois Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Verena Ilona Carrara
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Bahk YY, Ahn SK, Jeon HJ, Na BK, Lee SK, Shin HJ. An Evaluation of a New Quantitative Point-of Care Diagnostic to Measure Glucose-6-phosphate Dehydrogenase Activity. THE KOREAN JOURNAL OF PARASITOLOGY 2022; 60:281-288. [PMID: 36041490 PMCID: PMC9441449 DOI: 10.3347/kjp.2022.60.4.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/27/2022] [Indexed: 11/23/2022]
Abstract
Malaria continues to be one of the most crucial infectious burdens in endemic areas worldwide, as well as for travelers visiting malaria transmission regions. It has been reported that 8-aminoquinolines are effective against the Plasmodium species, particularly primaquine, for anti-hypnozoite therapy in P. vivax malaria. However, primaquine causes acute hemolytic anemia in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Therefore, G6PD deficiency testing should precede hypnozoite elimination with 8-aminoquinoline. Several point-of-care devices have been developed to detect G6PD deficiency. The aim of the present study was to evaluate the performance of a novel, quantitative G6PD diagnostics based on a metagenomic blue fluorescent protein (mBFP). We comparatively evaluated the sensitivity and specificity of the G6PD diagnostic modality with standard methods using 120 human whole blood samples. The G6PD deficiency was spectrophotometrically confirmed. The performance of the G6PD quantitative test kit was compared with that of a licensed control medical device, the G6PD strip. The G6PD quantitative test kit had a sensitivity of 95% (95% confidence interval (CI): 89.3–100%) and a specificity of 100% (95% CI: 94.3–100%). This study shows that the novel diagnostic G6PD quantitative test kit could be a cost-effective and time-efficient, and universally mandated screening tool for G6PD deficiency.
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Affiliation(s)
- Young Yil Bahk
- Department of Biotechnology, College of Biomedical and Health Science, Konkuk University, Chungju 27478, Korea
| | - Seong Kyu Ahn
- Infectious Diseases Investigation Division, Jeonnam Institute of Public Health and Environment, Muan 58568, Korea
| | - Heung Jin Jeon
- Infection Control Convergence Research Center, Chungnam National University College of Medicine, Deajeon 35015, Korea
| | - Byoung-Kuk Na
- Department of Parasitology and Tropical Medicine, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, Korea
| | - Sung-Keun Lee
- Department of Pharmacology, Inha University School of Medicine, Incheon 22212, Korea
- Corresponding authors (; )
| | - Ho-Joon Shin
- Department of Microbiology, Ajou University School of Medicine, Suwon 16499, Korea
- Corresponding authors (; )
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Bahr TM, Agarwal AM, Meznarich JA, Prince WL, Wait TWP, Prchal JT, Christensen RD. Thirty-five males with severe (Class 1) G6PD deficiency (c.637G>T) in a North American family of European ancestry. Blood Cells Mol Dis 2021; 92:102625. [PMID: 34773909 DOI: 10.1016/j.bcmd.2021.102625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/03/2021] [Indexed: 11/24/2022]
Abstract
In North America, jaundiced neonates are not usually tested for G6PD deficiency if the family is of European ancestry. However, we describe such a family where ≥35 males have had severe (Class I) G6PD deficiency. Many of the jaundiced neonates did not have this diagnosis considered, at least three of whom developed bilirubin neurotoxicity. Over seven generations 35 affected males were identified. Three developed signs of kernicterus spectrum disorder; three had exchange transfusions for hyperbilirubinemia; and nine received one or more blood transfusions during childhood.
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Affiliation(s)
- Timothy M Bahr
- Division of Neonatology, University of Utah Health, Salt Lake City, UT, USA; Neonatology, Intermountain Healthcare, Murray, UT, USA.
| | - Archana M Agarwal
- Division of Hematopathology, Department of Pathology, University of Utah Health, Salt Lake City, UT, USA; ARUP Laboratories, Salt Lake City, UT, USA
| | - Jessica A Meznarich
- Division of Hematology/Oncology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, USA
| | | | - Tirzah W P Wait
- Internal Medicine Service, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Josef T Prchal
- Division of Hematology, Department of Internal Medicine, University of Utah Health, the Huntsman Cancer Institute, and the George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Robert D Christensen
- Division of Neonatology, University of Utah Health, Salt Lake City, UT, USA; Division of Hematology/Oncology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, USA; Neonatology, Intermountain Healthcare, Murray, UT, USA
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Cortesi V, Manzoni F, Raffaeli G, Cavallaro G, Fattizzo B, Amelio GS, Gulden S, Amodeo I, Giannotta JA, Mosca F, Ghirardello S. Severe Presentation of Congenital Hemolytic Anemias in the Neonatal Age: Diagnostic and Therapeutic Issues. Diagnostics (Basel) 2021; 11:diagnostics11091549. [PMID: 34573891 PMCID: PMC8467765 DOI: 10.3390/diagnostics11091549] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/22/2021] [Accepted: 08/24/2021] [Indexed: 01/22/2023] Open
Abstract
Congenital hemolytic anemias (CHAs) are a group of diseases characterized by premature destruction of erythrocytes as a consequence of intrinsic red blood cells abnormalities. Suggestive features of CHAs are anemia and hemolysis, with high reticulocyte count, unconjugated hyperbilirubinemia, increased lactate dehydrogenase (LDH), and reduced haptoglobin. The peripheral blood smear can help the differential diagnosis. In this review, we discuss the clinical management of severe CHAs presenting early on in the neonatal period. Appropriate knowledge and a high index of suspicion are crucial for a timely differential diagnosis and management. Here, we provide an overview of the most common conditions, such as glucose-6-phosphate dehydrogenase deficiency, pyruvate kinase deficiency, and hereditary spherocytosis. Although rare, congenital dyserythropoietic anemias are included as they may be suspected in early life, while hemoglobinopathies will not be discussed, as they usually manifest at a later age, when fetal hemoglobin (HbF) is replaced by the adult form (HbA).
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Affiliation(s)
- Valeria Cortesi
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy; (V.C.); (F.M.); (G.S.A.); (S.G.); (F.M.)
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.C.); (I.A.)
| | - Francesca Manzoni
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy; (V.C.); (F.M.); (G.S.A.); (S.G.); (F.M.)
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.C.); (I.A.)
| | - Genny Raffaeli
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy; (V.C.); (F.M.); (G.S.A.); (S.G.); (F.M.)
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.C.); (I.A.)
- Correspondence: ; Tel.: +39-(25)-5032234; Fax: +39-(25)-503221
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.C.); (I.A.)
| | - Bruno Fattizzo
- UO Ematologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (B.F.); (J.A.G.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Giacomo Simeone Amelio
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy; (V.C.); (F.M.); (G.S.A.); (S.G.); (F.M.)
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.C.); (I.A.)
| | - Silvia Gulden
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy; (V.C.); (F.M.); (G.S.A.); (S.G.); (F.M.)
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.C.); (I.A.)
| | - Ilaria Amodeo
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.C.); (I.A.)
| | - Juri Alessandro Giannotta
- UO Ematologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (B.F.); (J.A.G.)
| | - Fabio Mosca
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy; (V.C.); (F.M.); (G.S.A.); (S.G.); (F.M.)
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.C.); (I.A.)
| | - Stefano Ghirardello
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
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Vela-Amieva M, Alcántara-Ortigoza MA, González-del Angel A, Belmont-Martínez L, López-Candiani C, Ibarra-González I. Genetic spectrum and clinical early natural history of glucose-6-phosphate dehydrogenase deficiency in Mexican children detected through newborn screening. Orphanet J Rare Dis 2021; 16:103. [PMID: 33637102 PMCID: PMC7913327 DOI: 10.1186/s13023-021-01693-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/17/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Glucose-6-phosphate dehydrogenase deficiency (G6PDd) newborn screening is still a matter of debate due to its highly heterogeneous birth prevalence and clinical expression, as well as, the lack of enough knowledge on its natural history. Herein, we describe the early natural clinical course and the underlying GDPD genotypes in infants with G6PDd detected by newborn screening and later studied in a single follow-up center. G6PDd newborns were categorized into three groups: group 1: hospitalized with or without neonatal jaundice (NNJ); group 2: non-hospitalized with NNJ; and group 3: asymptomatic. Frequencies of homozygous UGT1A1*28 (rs34983651) genotypes among G6PDd patients with or without NNJ were also explored. RESULTS A total of 81 newborns (80 males, one female) were included. Most individuals (46.9%) had NNJ without other symptoms, followed by asymptomatic (42.0%) and hospitalized (11.1%) patients, although the hospitalization of only 3 of these patients was related to G6PDd, including NNJ or acute hemolytic anemia (AHA). Nine different G6PDd genotypes were found; the G6PD A-202A/376G genotype was the most frequent (60.5%), followed by the G6PD A-376G/968C (22.2%) and the Union-Maewo (rs398123546, 7.4%) genotypes. These genotypes produce a wide range of clinical and biochemical phenotypes with significant overlapping residual enzymatic activity values among class I, II or III variants. Some G6PD A-202A/376G individuals had enzymatic values that were close to the cutoff value (5.3 U/g Hb, 4.6 and 4.8 U/g Hb in the groups with and without NNJ, respectively), while others showed extremely low enzymatic values (1.1 U/g Hb and 1.4 U/g Hb in the groups with and without NNJ, respectively). Homozygosity for UGT1A1*28 among G6PDd patients with (11.9%, N = 5/42) or without (10.3%, N = 4/39) NNJ did not shown significant statistical difference (p = 0.611). CONCLUSION Wide variability in residual enzymatic activity was noted in G6PDd individuals with the same G6PD genotype. This feature, along with a documented heterogeneous mutational spectrum, makes it difficult to categorize G6PD variants according to current WHO classification and precludes the prediction of complications such as AHA, which can occur even with > 10% of residual enzymatic activity and/or be associated with the common and mild G6PD A-376G/968C and G6PD A-202A/376G haplotypes.
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Affiliation(s)
- Marcela Vela-Amieva
- Laboratorio de Errores Innatos del Metabolismo Y Tamiz, Instituto Nacional de Pediatría SS, CDMX, Mexico
| | | | | | - Leticia Belmont-Martínez
- Laboratorio de Errores Innatos del Metabolismo Y Tamiz, Instituto Nacional de Pediatría SS, CDMX, Mexico
| | | | - Isabel Ibarra-González
- UGN, Instituto de Investigaciones Biomédicas, UNAM-LEIMyT, Instituto Nacional de Pediatría SS, CDMX, Mexico
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