Title: Background
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2ASSOCIATION 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
3G6PD 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
4G6PD 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.
5G6PD 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.
6G6PD 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 .
7G6PD 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 .
8G6PD 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.
9G6PD Def, Growth Failure and Low Serum
IronGrowth Parameters
10G6PD 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.
11??G6PD LEVELS
12G6PD 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.
13Hematocrit levels
14Serum iron levels
15G6PD 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.
16G6PD 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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