遗传性球形红细胞增多症合并G6PD缺乏1例报告

Hereditary spherocytosis accompanied with G6PD deficiency: a case report and literature review

目的探讨遗传性球形红细胞增多症(HS)合并葡萄糖-6-磷酸脱氢酶(G6PD)缺乏症的临床表现、发病机制和诊断经验。方法回顾分析1例5岁HS合并G6PD缺乏症患儿的临床表现、实验室检查,并复习国内外相关文献。结果患儿,男,5岁。因面色苍白伴黄疸,疑似地中海贫血就诊。红细胞计数2.65×10^(12)/L,血红蛋白70.50g/L,平均红细胞体积78.61 fl,平均球形红细胞体积66.26 fl,网织红细胞18%;镜检红细胞大小不等,以小细胞为主,球形红细胞约占15%;G6PD活性1.38 NBT;SDS-PAGE电泳和Western-blot均显示患儿带3蛋白部分缺失;基因结果显示,带3蛋白SLC4A1基因,一个位于4号外显子点突变c.113A>C,另一个位于6号内含子c.349+27C>T(IVS 6 nt+27 C>T),确诊HS合并G6PD缺乏症。讨论临床上同时患有HS和G6PD缺乏症十分罕见,双重红细胞缺陷影响溶血诊断。

Objective To discuss the clinical features, pathogenesis and diagnostic experience of hereditary spherocytosis （HS） accompanied with glucose-6-phosphate dehydrgenase deficiency （G6PD） deficiency.Methods Clinical features and diagnose of a 5-year-old case with HS accompanied with G6PD deifciency were analyzed, and realated literatures reviewed. Results The case was a 5-year-old boy referred to a hospital because of pallor and jaundice. Laboratory test results were as follows： red blood cell count 2.65×10^12/ L, hemoglobin 70.50 g/L, mean corpuscular volume 78.61 fl, and mean sphered corpuscular volume 66.26 lf, reticulocyte ratio 18%; G6PD activity was 1.38 NBT. The peripheral red blood cells were of different sizes and mature, and spherocytes were observed. SDS-polyacrylamide gel electrophoresis and western blot shows the band 3 was partially deletion. Molecular analysis revealed the band 3 deifciency was caused by two mutations： one was a missensemutation c.113〉C, and the other was a intron mutation c.349＋27〉T. A diagnosis of HS accompanied with G6PD deifciency was therefore arrived.Conclusions HS accompanied with G6PD deifciency is a relatively uncommon phenomenon and might lead to misdiagnosis. Blood smear staining, thalassemia screening, mean sphered corpuscular volume and other laboratory detections could improve the accuracy of diagnosis.