Acute hemolytic anemia as an initial presentation of Wilson disease in children.

Citation:
El Raziky, M. S., A. Ali, A. El Shahawy, and M. M. Hamdy, "Acute hemolytic anemia as an initial presentation of Wilson disease in children.", Journal of pediatric hematology/oncology, vol. 36, issue 3, pp. 173-8, 2014 Apr.

Abstract:

BACKGROUND: Wilson disease (WD) is an inherited disorder of copper metabolism. Hemolytic anemia in WD occurs in up to 17% of patients at some point during their illness.

AIM: To screen for WD among children presenting with hemolytic anemia.

METHODOLOGY: Twenty cases (mean age, 8.8 ± 3.9 y) with Coombs-negative hemolytic anemia, attending the hematology clinic of children hospital, Cairo University, were screened for WD by serum ceruloplasmin level, 24 hours urinary copper before and after D-penicillamine challenge test, and slit-lamp examination for detecting Kayser-Fleischer rings.

RESULTS: No case had low ceruloplasmin, whereas bilateral Kayser-Fleischer rings was detected in 5% of our cases. Urinary copper was elevated in 5% before and in 40% after D-penicillamine challenge test. According to the scoring system used, 1 case had definite WD and 7 cases were likely to have WD. These 8 (40%) cases were referred to as group B. Group B had a significantly lower hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin, and reticulocytes (P=0.04, 0.001, 0.04, and 0.04, respectively) and a significantly higher urinary copper after penicillamine (P=0.000) when compared with group A (unlikely WD).

CONCLUSION: WD is not uncommon in children with hemolytic anemia after exclusion of other common causes.

Notes:

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