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Clinical spectrum of pyruvate kinase deficiency: data from the Pyruvate Kinase Deficiency Natural History Study

RF. Grace, P. Bianchi, EJ. van Beers, SW. Eber, B. Glader, HM. Yaish, JM. Despotovic, JA. Rothman, M. Sharma, MM. McNaull, E. Fermo, K. Lezon-Geyda, DH. Morton, EJ. Neufeld, S. Chonat, N. Kollmar, CM. Knoll, K. Kuo, JL. Kwiatkowski, D....

. 2018 ; 131 (20) : 2183-2192. [pub] 20180316

Jazyk angličtina Země Spojené státy americké

Typ dokumentu časopisecké články, multicentrická studie, práce podpořená grantem

Perzistentní odkaz   https://www.medvik.cz/link/bmc19028519

An international, multicenter registry was established to collect retrospective and prospective clinical data on patients with pyruvate kinase (PK) deficiency, the most common glycolytic defect causing congenital nonspherocytic hemolytic anemia. Medical history and laboratory and radiologic data were retrospectively collected at enrollment for 254 patients with molecularly confirmed PK deficiency. Perinatal complications were common, including anemia that required transfusions, hyperbilirubinemia, hydrops, and prematurity. Nearly all newborns were treated with phototherapy (93%), and many were treated with exchange transfusions (46%). Children age 5 years and younger were often transfused until splenectomy. Splenectomy (150 [59%] of 254 patients) was associated with a median increase in hemoglobin of 1.6 g/dL and a decreased transfusion burden in 90% of patients. Predictors of a response to splenectomy included higher presplenectomy hemoglobin (P = .007), lower indirect bilirubin (P = .005), and missense PKLR mutations (P = .0017). Postsplenectomy thrombosis was reported in 11% of patients. The most frequent complications included iron overload (48%) and gallstones (45%), but other complications such as aplastic crises, osteopenia/bone fragility, extramedullary hematopoiesis, postsplenectomy sepsis, pulmonary hypertension, and leg ulcers were not uncommon. Overall, 87 (34%) of 254 patients had both a splenectomy and cholecystectomy. In those who had a splenectomy without simultaneous cholecystectomy, 48% later required a cholecystectomy. Although the risk of complications increases with severity of anemia and a genotype-phenotype relationship was observed, complications were common in all patients with PK deficiency. Diagnostic testing for PK deficiency should be considered in patients with apparent congenital hemolytic anemia and close monitoring for iron overload, gallstones, and other complications is needed regardless of baseline hemoglobin. This trial was registered at www.clinicaltrials.gov as #NCT02053480.

Ann and Robert H Lurie Children's Hospital of Chicago Chicago IL

Central Pennsylvania Clinic for Special Children and Adults Belleville PA Lancaster General Hospital Lancaster PA

Centre Hospitalier Universitaire Sainte Justine Montreal QC Canada

Charite Berlin Germany

Children's Hospital of Michigan Wayne State University School of Medicine Detroit MI

Children's Hospital of Pennsylvania and Perelman School of Medicine of the University of Pennsylvania Philadelphia PA

Children's Mercy Hospital Kansas City MO

Dana Farber Boston Children's Cancer and Blood Disorder Center Boston MA

DDC Clinic for Special Needs Children Middlefield OH

Division of Pediatric Hematology and Oncology Medical Center Faculty of Medicine University of Freiburg Freiburg Germany

Duke University Medical Center Durham NC

Emory University School of Medicine Aflac Cancer and Blood Disorders Center Children's Healthcare of Atlanta Atlanta GA

Fakultni Nemocnice Olomouc Olomouc Czech Republic

Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy

Klinikum Kassel GmbH Kassel Germany

Lucile Packard Children's Hospital Stanford University Palo Alto CA

McMaster University Hamilton ON Canada

Nationwide Children's Hospital The Ohio State University College of Medicine Columbus OH

Phoenix Children's Hospital Phoenix AZ

Primary Children's Hospital University of Utah Salt Lake City UT

Schwerpunktpraxis für Pädiatrische Hämatologie Onkologie Munich Germany

St Jude Children's Research Hospital Memphis TN

Texas Children's Hematology Center Baylor College of Medicine Houston TX

The University of Vermont Children's Hospital Burlington VT

Universitair Medisch Centrum Utrecht Utrecht The Netherlands

University of Massachusetts Memorial Children's Medical Center Worcester MA

University of Mississippi Medical Center Jackson MS

University of Toronto University Health Network Toronto ON Canada

Weill Cornell Medical College New York Presbyterian Hospital New York NY

Yale University School of Medicine New Haven CT

Zentrum für Kunder und Jugendmedizin Heidelberg Germany

Citace poskytuje Crossref.org

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