Glucose-6-phosphate dehydrogenase deficiency and Gilbert syndrome: a gene interaction underlies severe jaundice without severe hemolysis.
The authors describe the paradoxical clinical phenotype of an undetected severe hemolysis in parallel with the development of severe jaundice in a 13-year-old male suffering from a confirmed interaction of glucose-6-phosphate dehydrogenase deficiency (Mediterranean variant, 563 C/T) and Gilbert syndrome [variant (TA)7/(TA)7]. The child had 2 acute hemolytic episodes at the age of 10 and 13 years following infections of unknown origin. Both episodes were characterized by considerably high bilirubin levels (1st episode: 10.8 mg/dL, 2nd episode: 17.8 mg/dL) associated with unexpectably mild hemolysis indices (1st episode hemoglobin levels, 11.1 g/dL; reticulocyte counts, 2.5%; 2nd episode hemoglobin values, 12.7 g/dL; reticulocyte counts, 2.5%). During the steady-state condition of the child, hemoglobin values were within the normal ranges for his age (14.2 g/dL) and bilirubin levels were slightly elevated (1.70 mg/dL, indirect 1.5 mg/dL). The interaction of the two genetic abnormalities in the causation of this odd clinical phenotype is discussed.
Nicolaidou
P
P
Third Department of Pediatrics, University of Athens, Attikon Hospital, Athens, Greece.
Kostaridou
S
S
Mavri
A
A
Galla
A
A
Kitsiou
S
S
Stamoulakatou
A
A
D001663:Bilirubin / Q000097:blood; D002648:Child; D005878:Gilbert Disease / Q000097:blood* / Q000150:complications / Q000235:genetics; D005954:Glucosephosphate Dehydrogenase / Q000235:genetics; D005955:Glucosephosphate Dehydrogenase Deficiency / Q000097:blood* / Q000150:complications / Q000235:genetics; D006454:Hemoglobins / Q000032:analysis; D006461:Hemolysis / Q000235:genetics*; D006801:Humans; D007565:Jaundice / Q000097:blood* / Q000150:complications / Q000235:genetics; D008297:Male; D017701:Reticulocyte Count
D006454:Hemoglobins; D005954:Glucosephosphate Dehydrogenase; D001663:Bilirubin