Pyruvate kinase deficiency

• Causes, incidence, and risk factors

  Pyruvate kinase deficiency is passed down as an autosomal recessive trait. A child must receive the non-working gene from both parents to develop the disorder.

  There are many different types of enzyme-related defects of the red blood cell that can cause hemolytic anemia. Pyruvate kinase deficiency is the second most common cause, after G-6-PD deficiency.

  Pyruvate kinase deficiency is found in people of all ethnic backgrounds. However, certain populations, such as the Amish, are somewhat more likely to develop the condition.

• Symptoms
  • Anemia
  • A yellowing of the whites of the eyes (icterus)
  • Fatigue, lethargy
  • Jaundice
  • Pale skin (pallor)
• Signs and tests

  During a physical exam, the doctor will look for an enlarged spleen.

  Tests include the following:

  • Bilirubin in the blood
  • CBC
  • Genetic testing for mutation in the pyruvate kinase gene
  • Large red blood cells (macrocytosis)
  • Levels of haptoglobin in the blood
  • Osmotic fragility
  • Pyruvate kinase activity
  • Stool urobilinogen
• Treatment

  People with severe anemia may need blood transfusions. Removing the spleen (splenectomy) may help reduce the destruction of red blood cells. However, this does not help in all cases. In newborns with dangerous levels of jaundice, the health care provider may recommend an exchange transfusion.

  Someone who had a splenectomy should receive the pneumococcal vaccine at recommended intervals. They also should receive preventive antibiotics until age 5.

• Expectations (prognosis)

  The outcome varies. Some people have few or no symptoms. Others have severe symptoms. Treatment can usually make symptoms less severe.

• Complications

  Gallstones are a common problem. They are made of too much bilirubin, which is produced during hemolytic anemia. Severe pneumococcal disease is a possible complication after splenectomy.

• Calling your health care provider

  See your health care provider if:

  • You have jaundice (this is a symptom of many severe illnesses)
  • You have a family history of this disorder and are planning to have children
• Prevention

  Genetic counseling can help prospective parents with a family history of pyruvate kinase deficiency. People who carry the gene can often be diagnosed by finding decreased RBC pyruvate kinase activity in their red blood cells.

• References

  Segel GB. Enzymatic defects. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 463.

Review Date: 1/21/2010

Reviewed By: Chad Haldeman-Englert, MD, Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.