title: Clinical characteristics of hemolytic uremic syndrome secondary to cobalamin C disorder in Chinese children.
abstract: BACKGROUND
  The present study was undertaken to investigate the clinical characteristics of hemolytic uremic syndrome (HUS) secondary to cobalamin C disorder (cbl-C disorder).
  
  
  METHODS
  We reviewed retrospectively the medical records of 3 children with HUS secondary to cbl-C disorder who had been treated between April 1, 2009 and October 31, 2013.
  
  
  RESULTS
  The 3 patients with HUS secondary to cbl-C disorder presented with progressive hemolytic anemia, acute renal failure, thrombocytopenia, poor feeding, and failure to thrive. Two of the 3 patients once had high blood pressure. The mutations of c.609G>A (p.W203X), c.217C>T (p.R73X) and c.365A>T (p.H122L) in the methylmalonic aciduria (cobalamin deficiency) cbl-C type, with homocystinuria gene were detected in the 3 patients. In these patients the levels of lactate dehydrogenase and homocysteine in serum were elevated and the level of methylmalonic acid (MMA) in urine was also elevated. After treatment with hydroxocobalamin, 2 patients were discharged with no obvious abnormal growth and neurological development and 1 patient died of multiple organ failure.
  
  
  CONCLUSIONS
  The results of this study demonstrated that cbl-C disorder should be investigated in any child presenting with HUS. The high concentrations of homocysteine and MMA could be used for timely recognization of the disease. Once the high levels of plasma homocystein and/or plasma or urine MMA are detected, the treatment with parenteral hydroxocobalamin should be prescribed immediately. The early diagnosis and treatment would contribute to the good prognosis of the disease.
authors.affiliation: Department of Laboratory Medicine, Beijing Children's Hospital, Capital Medical University, Beijing, China.
authors.forename: Qi-Liang
authors.initials: QL
authors.lastname: Li
authors.forename: Wen-Qi
authors.initials: WQ
authors.lastname: Song
authors.forename: Xiao-Xia
authors.initials: XX
authors.lastname: Peng
authors.forename: Xiao-Rong
authors.initials: XR
authors.lastname: Liu
authors.forename: Le-Jian
authors.initials: LJ
authors.lastname: He
authors.forename: Li-Bing
authors.initials: LB
authors.lastname: Fu
mesh_terms: D002352:Carrier Proteins / Q000235:genetics*; D002675:Child, Preschool; D002681:China; D005260:Female; D005500:Follow-Up Studies; D020022:Genetic Predisposition to Disease; D006463:Hemolytic-Uremic Syndrome / Q000209:etiology / Q000235:genetics* / Q000503:physiopathology / Q000628:therapy*; D006710:Homocysteine / Q000378:metabolism; D006801:Humans; D007223:Infant; D008297:Male; D009154:Mutation; D010088:Oxidoreductases; D035583:Rare Diseases; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014805:Vitamin B 12 / Q000627:therapeutic use*; D014806:Vitamin B 12 Deficiency / Q000150:complications / Q000188:drug therapy / Q000235:genetics*
chemical_list: D002352:Carrier Proteins; D006710:Homocysteine; C508359:MMACHC protein, human; D010088:Oxidoreductases; D014805:Vitamin B 12