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Also failure to thrive and iron deficiency is common in developing countries especially in low income sectors of the population . – PowerPoint PPT presentation

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Title: Background


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ASSOCIATION OF GROWTH FAILURE AND LOW SERUM IRON
IN G6PD DEFICIENT CHILDREN
  • Y K Abu-Osba, L B El-Asir,
  • D A Al-Masri, H I Dawood
  • Neonatal Medicine, Jordan Hospital, Amman, Jordan

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G6PD DEFICIENCY, GROWTH FAILURE AND LOW SERUM
IRON Background
  • G6PD deficiency (G6PD-D) is not uncommon in
    Jordan as well as in many Arab World countries.
    Also failure to thrive and iron deficiency is
    common in developing countries especially in low
    income sectors of the population .
  • About 400 million people worldwide have G6PD
    deficiency, making it the most common inherited
    enzyme deficiency. In those who are born with it,
    either the red blood cells do not make enough of
    the enzyme or the G6PD produced is altered and
    cannot function properly

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G6PD DEFICIENCY, GROWTH FAILURE AND LOW SERUM
IRON Background-2
  • G6PD, is just one of the many enzymes that affect
    cell metabolism. G6PD is produced by red blood
    cells and helps the body process carbohydrates,
    turning them into energy .
  • Normal functioning of G6PD is also important to
    the body because it protects the red blood cells
    from the stress of oxidizing substances. These
    are potentially harmful byproducts that are
    created when certain medications are taken or
    when the body's immune system is working hard to
    fight infection.

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G6PD DEFICIENCY, GROWTH FAILURE AND LOW SERUM
IRON Aim of the study
  • Association of G6PD-D and growth failure had not
    been described to our knowledge. Also association
    of low serum iron and G6PD-D has not been
    reported.  
  • The aim of this report is to draw attention to
    the combination of these findings G6PD-D, low
    serum iron and failure to thrive.  

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G6PD DEFICIENCY, GROWTH FAILURE AND LOW SERUM
IRON Setting and Methods
  • We conducted the observations at Jordan
    Hospital Medical Center and Clinics .
  • Patients seen in the outpatient clinic
    suffering from failure to thrive (FTT) were
    screened for common causes of FTT as indicated by
    the clinical presentation .

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G6PD DEFICIENCY, GROWTH FAILURE AND LOW SERUM
IRON Methods
  • Investigations included complete blood count,
    urine and stool analysis, kidney function,
    serum iron, total iron binding capacity,
    ferritin, growth hormone, IGF, G6PD
    level in red blood cells.
  • G6PD determinations were done by the Trinity
    Biotech procedure which is a modification
    of the spectrophotometric methods of
    Komberg and Horecker and of Lohr and
    Waller method .
  • Some of the investigations were not done for
    clinical or financial reasons .

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G6PD DEFICIENCY, GROWTH FAILURE AND LOW SERUM
IRON Results
  • Thirteen children were investigated for poor
    weight gain or decelaration of their physical
    growth.
  • Age ranged between 3 months to 11years.
  • Weight was below 10th centile in 11 children, and
    two had steady decrease in their weight centile
    for age.

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G6PD Def, Growth Failure and Low Serum
IronGrowth Parameters

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G6PD DEFICIENCY, GROWTH FAILURE AND LOW SERUM
IRON Results
  • G6PD levels range between 20 to 155, average 114,
    SD 46.55 mU/109 erythrocytes , normal for newborn
    219-564 and for children (1m to 1year of age) and
    adults 186-473 and146-376 mU/109 respectively.

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??G6PD LEVELS
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G6PD DEFICIENCY, GROWTH FAILURE AND LOW SERUM
IRON Results
  • None of the patients were anemic except one ,
    hemoglobin range 8.6-12.8 g/dL, average 11.4, and
    SD 0.67 gm (normal Hgb 10.3-14.9).
  • Serum iron was measured in 11 patients, 8
    children had lower serum iron than normal, range
    14 to 32, average 21.75, SD 7.2 (normal 37-158
    ug/dl). Serum iron was not done in two patients .
    Total iron binding capacity was within normal in
    8 patients, high in one patient, and not done in
    two.
  • Other tests results were unremarkable.

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Hematocrit levels
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Serum iron levels
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G6PD DEFICIENCY, GROWTH FAILURE AND LOW SERUM
IRON Conclusions
  • We described an association of weight gain
    failure / deceleration and low serum iron in
    thirteen children with G6PD-D.
  • We did not establish a cause and effect
    findings.
  • We want to draw the attention of the possible
    presence of these findings together although
    we expect normal or high serum iron with
    possible chronic / acute hemolysis in
    G6PD-deficient patients.

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G6PD DEFICIENCY, GROWTH FAILURE AND LOW SERUM
IRON Recommendations
  • We recommend a longitudinal controlled double
    blind study to clarify these findings, and screen
    all newborns for G6PD deficiency in high risk
    areas.

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