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Anemia due to Glutathione Metabolism Disorder

Hemolytic Anemia Due to Glutathione Metabolism Disorder


Presentation

  • Individuals with hemolytic anemia can present with fatigue, pallor, irregular heartbeats, lightheadedness, and shortness of breath. Hemolytic anemia is found in all forms.[emedicine.medscape.com]
  • Since glutathione is continuously synthesized and broken down, the amount of glutathione present in the blood depends on the balance between its rate of synthesis and its rate of use.[clinicaltrials.gov]
  • SCN often presents with infections in the first month of life, while AIN usually presents later. The incidence and severity of bacterial infections is usually much less in AIN than in SCN.[jcp.bmj.com]
  • Conclusion In the present study, we observed increased oxidative stress in terms of elevated serum MDA, serum NO, plasma Protein carbonyl and erythrocytic SOD activity.[jcdr.net]
  • Chronic nonspherocytic hemolytic anemia due to G6PD deficiency presents with: Neonatal jaundice, An enlarged spleen; and Increased chance of gallstones (bilirubin stones due to increased bilirubin from heme breakdown).[pathophys.org]
Anemia
  • Congenital spherocytic anemia Ferritin Folate-deficiency anemia Hemoglobin electrophoresis Hemolytic anemia Hemolytic anemia caused by chemicals and toxins Immune hemolytic anemia Iron deficiency anemia Managing Chemotherapy Side Effects: Anemia - NIH[coding-pro.com]
  • NIH: National Heart, Lung, and Blood Institute Anemia (Medical Encyclopedia) Anemia - B12 deficiency (Medical Encyclopedia) Anemia caused by low iron -- infants and toddlers (Medical Encyclopedia) Anemia of chronic disease (Medical Encyclopedia) Anemia[icdlist.com]
  • Anemia due to G6PD deficiency Anemia due to glutathione reductase deficiency Anemia due to pentose phosphate pathway defect Anemia, G6PD deficiency Anemia, glutathione reductase deficiency Drug-induced enzyme deficiency anemia Erythrocyte enzyme deficiency[icd9data.com]
  • D53 Other nutritional anemias D53.0 Protein deficiency anemia D53.1 Other megaloblastic anemias, not elsewhere classified D53.2 Scorbutic anemia D53.8 Other specified nutritional anemias D53.9 Nutritional anemia, unspecified D55 Anemia due to enzyme[icd10data.com]
  • Similar Codes ICD-10 Code ICD-10 Description D55 Anemia due to enzyme disorders D55.0 Anemia due to glucose-6-phosphate dehydrogenase [G6PD] deficiency D55.2 Anemia due to disorders of glycolytic enzymes D55.3 Anemia due to disorders of nucleotide metabolism[healthprovidersdata.com]
Pallor
  • Individuals with hemolytic anemia can present with fatigue, pallor, irregular heartbeats, lightheadedness, and shortness of breath. Hemolytic anemia is found in all forms.[emedicine.medscape.com]
  • Pallor of anaemia. During a crisis jaundice occurs. Back or abdominal pain (usually occurs when 50% haemolysis occurs). Splenomegaly may occur. Investigations FBC - anaemia.[patient.info]
  • Sensitive individuals suffer from acute hemolytic anemia upon exposure with characteristic symptoms that include pallor, fatigue, dyspnea, nausea, abdominal and/or back pain, fever, and chills.[farrp.unl.edu]
  • After 2-4 days of oxidative injury, signs and symptoms of acute hemolysis like jaundice, pallor and dark urine are observed. In spite of continuous drug exposure, the episode is self-limiting and ends in about a week.[medcaretips.com]
  • There is the sudden onset of jaundice, pallor, and dark urine, with or without abdominal and back pain usually two to four days after drug ingestion,.[ayubmed.edu.pk]
Chills
  • Hemolytic anemia is characterized by chills, dark urine, fatigue and a rapid heart rate. If left untreated, the anemia can lead to failure of the heart and blood pressure, and ultimately death, according to Medline Plus.[livestrong.com]
  • Sensitive individuals suffer from acute hemolytic anemia upon exposure with characteristic symptoms that include pallor, fatigue, dyspnea, nausea, abdominal and/or back pain, fever, and chills.[farrp.unl.edu]
  • Headache, nausea, back pain, chills and fever occur followed by anemia, jaundice and blood in urine. Hemoglobin level may fall down severely and abruptly requiring blood transfusion.[medcaretips.com]
Amyloidosis
  • Adrenal hypoplasia NR0B1 Alkaptonuria HGD Alpha-2-macroglobulin deficiency A2M Alpha-ketoglutarate dehydrogenase deficiency OGDH Alpha-methylacyl CoA racemase deficiency AMACR Aminoacylase deficiency ACY1 AMP deaminase deficiency, erythrocytic AMPD3 Amyloidosis[centogene.com]
  • […] histiocytosis syndromes Reticulohistiocytoma (giant-cell) Sinus histiocytosis with massive lymphadenopathy Xanthogranuloma D77 Other disorders of blood and blood-forming organs in diseases classified elsewhere [ edit ] Code first underlying disease, such as: amyloidosis[en.wikisource.org]
Dizziness
  • […] have enough iron, folic acid or vitamin B12 Blood disorders such as sickle cell anemia and thalassemia, or cancer Aplastic anemia, a condition that can be inherited or acquired G6PD deficiency, a metabolic disorder Anemia can make you feel tired, cold, dizzy[icdlist.com]
  • […] enough iron, folic acid or vitamin B12 Blood disorders such as sickle cell anemia and thalassemia , or cancer Aplastic anemia , a condition that can be inherited or acquired G6PD deficiency , a metabolic disorder Anemia can make you feel tired, cold, dizzy[coding-pro.com]
  • Symptoms of deficiency may include: Headaches Dizziness Lack of energy/feelings of weakness Joint pain Rashes Sleep disorders Depression Find it in these food sources Glutathione is found in the following foods: Asparagus Avocados Spinach Broccoli Tomatoes[clicks.co.za]
  • Signs and symptoms [ edit ] Signs and symptoms of methemoglobinemia (methemoglobin level above 10%) include shortness of breath, cyanosis , mental status changes ( 50%), headache, fatigue, exercise intolerance , dizziness, and loss of hairlines.[en.wikipedia.org]
Dark Urine
  • Hemolytic anemia is characterized by chills, dark urine, fatigue and a rapid heart rate. If left untreated, the anemia can lead to failure of the heart and blood pressure, and ultimately death, according to Medline Plus.[livestrong.com]
  • Clinical features of an acute hemolytic anemia episode Symptom Sign/lab finding Mechanism Weakness/fatigue Anemia Hemolysis Jaundice Accumulation of unconjugated bilirubin Splenomegaly Not usually expected, consider coexisting disease Dark urine Hemoglobinuria[pathophys.org]
  • After 2-4 days of oxidative injury, signs and symptoms of acute hemolysis like jaundice, pallor and dark urine are observed. In spite of continuous drug exposure, the episode is self-limiting and ends in about a week.[medcaretips.com]
  • There is the sudden onset of jaundice, pallor, and dark urine, with or without abdominal and back pain usually two to four days after drug ingestion,.[ayubmed.edu.pk]

Workup

Heinz Bodies
  • Simultaneously with the onset of hypercupriuria serum copper, ceruloplasmin, and erythrocyte copper increased, and hemolytic anemia associated with the formation of Heinz bodies on exposure to acetylphenylhydrazine developed.[annals.org]
  • Heinz bodies (intracellular hemoglobin precipitates) form from oxidized, denatured hemoglobin which is no longer soluble.[pathophys.org]
  • Severe symptoms include formation of Heinz bodies in RBCs, jaundice, hematuria and dark-colored urine. Heinz bodies form as a result of disulfide crosslinked aggregates of oxidized hemoglobin.[quizlet.com]
  • Heinz bodies appear in the red cells, and the hemoglobin concentration begins to decline rapidly.[g6pd.org]
  • Heinz bodies) by the spleen. Polychromasia, basophilic stippling, microspherocytes and nucleated RBCs may also be seen. Demonstration of Heinz bodies: Supra vital staining of peripheral blood film using brilliant cresyl blue may reveal Heinz bodies.[medcaretips.com]
Haptoglobin Decreased
  • Decreased Hemoglobinuria Liver function tests Elevated indirect bilirubin Scleral icterus Coombs’ test Negative Drugs that cause hemolysis in G6PD-deficient persons inf lict oxidative damage to erythrocytes leading to erythrocyte destruction.[aafp.org]

Treatment

  • Treatment depends on the kind of anemia you have.[icdlist.com]
  • […] features: Similar to sulfite oxidase deficiency but also urinary stones Treatment: No effective treatment Low sulfur diet possibly helpful in patients with milder symptoms Molybdopterin synthase MCOS2 (6p21.3)* Gephyrin GEPH (5q21)* *Gene has been identified[merckmanuals.com]
  • Treatment of hemolytic anemia involves treatment of the glutathione deficiency. Another symptom of mild glutathione synthetase deficiency is the excretion of 5-oxoproline in the urine.[livestrong.com]
  • Healthcare providers give glutathione as a shot (by injection into the muscle) for preventing poisonous side effects of cancer treatment ( chemotherapy ) and for treating the inability to father a child (male infertility ).[webmd.com]

Prognosis

  • Prognosis A long-term follow up study of 28 patients with glutathione synthetase deficiency has showed that the factors most predictive of survival and long-term outcome are early diagnosis, correction of acidosis and early supplementation with vitamin[orpha.net]
  • The prognosis for the moderate form is intermediate. In mild glutathione synthetase deficiency, hemolytic anemia is the primary finding with apparently no effects outside of erythrocytes. Individuals with this form do well clinically.[emedicine.medscape.com]
  • Complications and prognosis Most people with G6PD deficiency have a normal life expectancy despite a predisposition to neonatal jaundice and sensitivity to certain drugs.[patient.info]
  • Long-term prognosis is guarded. With careful treatment during infancy, many patients survive, and the metabolic acidosis may become more manageable after infancy.[emedicine.medscape.com]

Etiology

  • Etiology Several mutations have been identified in the gene encoding glutathione synthetase, localized to chromosome 20q11.2.[orpha.net]
  • […] or red cell morphology, anemias are most often classified according to their: • Etiology/Mechanism o Blood loss o Increased red cell destruction (hemolysis) o Decreased red cell production • Red Cell Morphology o Red cell size: normocytic, microcytic[quizlet.com]
  • On the other hand, if an unusual thermolabile variant is found, it is more likely that the G-6-PD deficiency plays an etiologic role in the hemolytic process.[g6pd.org]
  • Etiology G6PD gene is on the X chromosome: Males can be G6PD normal or deficient Females can be G6PD normal, intermediate (heterozygous) or deficient (homozygous) In heterozygous females, X-inactivation causes variability of G6PD activity from cell to[pathophys.org]

Epidemiology

  • Summary Epidemiology This disease has been detected in at least 70 patients in more than 50 families worldwide. Etiology Several mutations have been identified in the gene encoding glutathione synthetase, localized to chromosome 20q11.2.[orpha.net]
  • The epidemiology of G6PD deficiency has been noted to be remarkably similar to that of malaria, adding support to the 'malaria protection hypothesis'.[patient.info]
  • A milder form is restricted to erythrocyctes Relevant External Links for GSS Genetic Association Database (GAD) GSS Human Genome Epidemiology (HuGE) Navigator GSS Atlas of Genetics and Cytogenetics in Oncology and Haematology: GSS Molecular basis of glutathione[genecards.org]
  • Epidemiology Frequency United States The frequency of glutathione synthetase deficiency is unknown. International Glutathione synthetase deficiency is very rare.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • Moreover, it appears reasonable to assume that novel, unidentified ion homeostasis disturbances may significantly contribute to anaemia pathophysiology and may constitute an important group of undiagnosed cases of RA.[rare-anaemia.eu]
  • Pathophysiology Glutathione is involved in several important biologic functions, including membrane transport, detoxification of xenobiotics, and protection of cells from free radicals.[emedicine.medscape.com]
  • Pathophysiology The disease is X-linked with about 300 variants reported. Most of the variants occur sporadically and are single amino acid defects in a protein of 515 amino acids.[patient.info]
  • Several physiological and pathophysiological functions of RBC-derived microvesicles have been described.[frontiersin.org]
  • These particular diseases are covered either because they are common or because they illustrate important pathophysiologic features (or both). A.[web2.iadfw.net]

Prevention

  • People take glutathione by mouth for treating cataracts and glaucoma , preventing aging, treating or preventing alcoholism , asthma , cancer , heart disease ( atherosclerosis and high cholesterol ), hepatitis , liver disease, diseases that weaken the[webmd.com]
  • Glutathione synthetase deficiency is a disorder that prevents the production of an important molecule called glutathione. Glutathione helps prevent damage to cells by neutralizing harmful molecules generated during energy production.[ghr.nlm.nih.gov]
  • Seite 196 - Prevention of experimental allergic encephalomyelitis by targeting nitric oxide and peroxynitrite: implications for the treatment of multiple sclerosis. Proc. Natl. Acad. Sci. USA 94, 2528-2533. ‎[books.google.de]
  • Glutathione acts to prevent damage to cells by deactivating harmful molecules produced during energy production. Symptoms of glutathione synthetase deficiency are dependent on the severity of the disease.[livestrong.com]

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