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[Diagnosis and gene analysis of congenital hemolytic anemia].

Congenital hemolytic anemia is relatively uncommon and tends to be left undiagnosed because unusual special tests outside health insurance adaptation are needed for the diagnosis. To diagnose properly these patients, we instituted a comprehensive examination system for hemolytic anemia in Fukuoka University Hospital in 1990. In addition to basic laboratory tests, investigation of hemoglobin, SDS-PAGE analysis of red blood cell membrane proteins, a complete panel of red cell enzyme measurements and gene analysis were included. The red cell enzyme measurements was facilitated by the automation on the COBAS MIRA instrument (NIPPON ROCHE). By such a comprehensive examination, we have identified and confirmed 382 cases of congenital hemolytic anemia which otherwise would have escaped detection during the period October 1990 to September 2005 in our institution. SDS-PAGE procedure contributed to the diagnosis of 24 cases of band 3 deficiency, 13 cases of band 4.2 deficiency and 13 cases of band 4.1 deficiency. Hemoglobin studies uncovered 20 cases of abnormal hemoglobins, 126 cases of beta thalassemia and 7 cases of alpha thalassemia. Red cell enzyme measurements were also contributory to the diagnosis of 29 cases of hemolytic anemia in which enzyme levels were reduced.

Anemia, Hemolytic, Congenital↗

Clinical features and splenic pathologic changes in patients with autoimmune hemolytic anemia and congenital hemolytic anemia.

We characterized the pathologic changes in 50 spleens from patients with autoimmune hemolytic anemia and in 13 spleens from patients with congenital hemolytic anemia. The major pathologic findings in autoimmune hemolytic anemia were mild to pronounced cord congestion and variable white pulp area, erythrophagocytosis in conjunction with an increased polymorphonuclear neutrophil reaction, and increased deposition of hemosiderin and extramedullary hematopoiesis. In contrast, both the severity and the frequency of polymorphonuclear neutrophil reactions, deposition of hemosiderin, and extramedullary hematopoiesis were less in patients with congenital hemolytic anemia, and prominent cord congestion associated with an empty or collapsed sinus was noted in patients with hereditary spherocytosis. The activity of erythrophagocytosis in the sinus was more distinct in patients with congenital hemolytic anemia, especially those with nonspherocytic congenital hemolytic anemia, than in patients with autoimmune hemolytic anemia. These findings are consistent with the existence of different mechanisms of trapping and destruction of erythrocytes in autoimmune hemolytic anemia and congenital hemolytic anemia.

Adolescent↗

Two cases of phosphofructokinase deficiency associated with congenital hemolytic anemia found in Japan.

Two kindreds of phosphofructokinase (PFK) deficiency associated with congenital nonspherocytic hemolytic anemia and mild myopathy were found in Japan. Both probands had jaundice, gallstones, and slight to moderate degree of exercise intolerance. They showed decreased level of red cell PFK activity and no increase of blood lactate in forearm ischemic exercise test. We studied these probands' red cell PFKs by partial purification and condensation. Muscle type isozyme of PFK in both cases was not demonstrable in starch gel electrophoresis and DEAE-Sephadex chromatography. The clinical symptoms are considered to be due to a defect of muscle type isozyme.

Adult↗

Successful long-term phenobarbital therapy of hyperbilirubinemia in congenital hemolytic anemia due to glucose phosphate isomerase deficiency.

Long-term phenobarbital treatment (2 mg/kg body weight/day) permanently reduced hyperbilirubinemia in a patient with congenital non-spherocytic hemolytic anemia due to erythrocyte glucose phosphate isomerase deficiency. Phenobarbital treatment is recommended in patients with congenital hemolytic anemia in whom hyperbilirubinemia is not improved by splenectomy or in whom splenectomy is not indicated. Early phenobarbital treatment may prevent the development of cholelithiasis in patients with chronic hemolysis.

Anemia, Hemolytic, Congenital↗

G6PD San Francisco: a new variant of glucose-6-phosphate dehydrogenase associated with congenital nonspherocytic hemolytic anemia.

Congenital nonspherocytic hemolytic anemia in an adult male of Scandinavian ancestry was associated with virtual absence of G6PD activity in red cells. Characterization of G6PD purified from leukocytes using standard WHO techniques revealed diminished electrophoretic mobility, marked lability on heating at 46 degrees C, normal pH optimum and utilization of alternate substrates (2-deoxy G6P, D-amino NADP), elevated Km NADP, and striking susceptibility to NADPH inhibition. The variant G6PD, which appears to be unique, has been designated G6PD San Francisco. An unusual feature of the variant enzyme, susceptibility to inactivation by brief periods of dialysis, could be prevented by addition of 200 microM NADP to the dialysis solution. In red cells, where G6PD activity was essentially absent, regeneration of reduced glutathione was totally curtailed in vitro, while in leukocytes, where residual G6PD activity was approximately 60% of normal, hexose monophosphate shunt activity, oxygen consumption during phagocytosis, and bacterial killing were unimpaired. Thus, instability of the variant enzyme rather than its unfavorable kinetics appeared to be an important determinant of abnormal cell function.

Adult↗

G6PD Sendagi: a new glucose-6-phosphate dehydrogenase variant associated with congenital hemolytic anemia.

A new glucose-6-phosphate dehydrogenase (G6PD) variant associated with chronic nonspherocytic hemolytic anemia was discovered. It was found in a 2-year-old male who had a hemolytic crisis after an upper respiratory tract infection. The enzyme activity of the variant was 8.4% of that of the normal enzyme. The enzymatic characteristics were slower than normal anodal electrophoretic mobility, low Km G6P, normal Km NADP, increased utilization of substrate analogues, high Ki NADPH, decreased heat stability, and an alkaline pH optimum. From these results, this was considered to be a new variant and was designated G6PD Sendagi.

Anemia, Hemolytic, Congenital↗

Adenosine deaminase (ADA) overproduction associated with congenital hemolytic anemia: case report and molecular analysis.

We report the fourth case of adenosine deaminase (ADA) overproduction associated with hereditary nonspherocytic hemolytic anemia and the molecular analysis of this anomaly. The proband was a 10-year-old Japanese boy, who had an episode of erythroblastosis fetalis during the perinatal period. The red cell ADA activity showed a 110-fold increase and the red cell ATP level was about 64% of the comparably reticulocyte-rich controls, but the lymphocyte ADA activity was within the normal range. Western blotting of partially purified ADA from red cells revealed an increased amount of enzyme in the patient's red cells. No gene amplification or gene rearrangement was found by Southern blot analysis, and no increase of ADA mRNA in reticulocyte RNA was detected by dot blot analysis using ADA cDNA. We constructed a genomic DNA library and obtained three clones containing the 5'-promoter region of ADA gene. The 2.2 kb ADA promoter DNA fragment of these clones was fused to the chloramphenicol acetyl transferase (CAT) gene, and transfected to human erythroid cell line K562, and assayed for CAT activity. One of the clones, pADOP 2 cat, expressed about 2.6 times higher CAT activity than the normal ADA promoter fused to CAT gene in K562, but such enhancement was not seen in human non-erythroid cell lines; HL 60 and Raji. From these results, it is most likely, though not conclusive, that the 5' promotor fragment of the ADA gene of the patient was responsible for the cell-specific enhancement of protein synthesis.

Adenosine Deaminase↗

Transfusion therapy in congenital hemolytic anemias.

Transfusion with red blood cells is a mainstay in the prevention or treatment of complications associated with the more serious congenital hemolytic anemias. These disorders include hemoglobinopathies, red cell enzyme deficiency disorders, and abnormalities of the red cell membrane. Particular emphasis is devoted to the relatively common hemoglobin disorders, including sickle cell disease and thalassemia syndromes.

Anemia, Hemolytic, Congenital↗

[Abnormal cation transport in erythrocyte membranes during congenital hemolytic anemia (author's transl)].

In this paper we review our knowledge on: 1. The physiological mechanisms of constant low Na+, high K+ concentration in human red blood cells (cation content, cation movements through the erythrocyte membrane, membrane ATPases). 2. The pathologic findings observed in congenital hemolytic anemia. These alterations may explain hyperhemolysis in numerous diseases. In no case a primary genetically transmitted abnormal erythrocyte membrane protein can be formely demonstrated.

Adenosine Triphosphatases↗

Erythrocyte fructose 2,6-bisphosphate content in congenital hemolytic anemias.

We have investigated the levels of fructose 2,6-bisphosphate and its synthesizing enzyme 6-phosphofructo-2-kinase in red blood cells from different congenital anemias. Fructose 2,6-bisphosphate concentration and 6-phosphofructo-2-kinase activity are markedly influenced by the number of reticulocytes in all the cases studied with the exception of homozygous pyruvate kinase deficiency, where no correlation was observed with the percentage of reticulocytes.

Anemia, Hemolytic, Congenital↗