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Clinical characteristics of hemolytic uremic syndrome secondary to cobalamin C disorder in Chinese children

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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.

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Authors and Affiliations

  1. Department of Laboratory Medicine, Beijing Children’s Hospital, Capital Medical University, Beijing, China

    Qi-Liang Li & Wen-Qi Song

  2. Department of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Capital Medical University, Beijing, China

    Xiao-Xia Peng

  3. Department of Nephrology, Beijing Children’s Hospital, Capital Medical University, Beijing, China

    Xiao-Rong Liu

  4. Department of Pathology, Beijing Children’s Hospital, Capital Medical University, Beijing, China

    Le-Jian He & Li-Bing Fu

  5. Department of Laboratory Medicine, Beijing Children’s Hospital, Capital Medical University, Beijing, 100045, China

    Wen-Qi Song

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  1. Qi-Liang Li
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  3. Xiao-Xia Peng
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Correspondence to Wen-Qi Song.

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Li, QL., Song, WQ., Peng, XX. et al. Clinical characteristics of hemolytic uremic syndrome secondary to cobalamin C disorder in Chinese children. World J Pediatr 11, 276–280 (2015). https://doi.org/10.1007/s12519-015-0032-4

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  • DOI: https://doi.org/10.1007/s12519-015-0032-4

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