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

J Pediatr Hematol Oncol. 2014 Apr;36(3):173-8. doi: 10.1097/MPH.0000000000000127.

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.

MeSH terms

  • Acute Disease
  • Adolescent
  • Anemia, Hemolytic / diagnosis*
  • Anemia, Hemolytic / metabolism
  • Ceruloplasmin / metabolism
  • Chelating Agents / metabolism
  • Child
  • Child, Preschool
  • Cohort Studies
  • Diagnosis, Differential
  • Female
  • Follow-Up Studies
  • Hepatolenticular Degeneration / diagnosis*
  • Hepatolenticular Degeneration / metabolism
  • Humans
  • Liver Function Tests
  • Male
  • Penicillamine / metabolism
  • Prognosis

Substances

  • Chelating Agents
  • Ceruloplasmin
  • Penicillamine