Hemolysis in children with Glucose-6-Phosphate Dehydrogenase deficiency after ingestion of fava beans; facts predicting severity

Authors

  • Hasanein Habeeb Ghali Department of Pediatrics, College of Medicine, University of Baghdad, Children Welfare Teaching Hospital, Baghdad Medical City, Baghdad, Iraq.
  • Doaa Alem Al Mamoori Department of Emergency Medicine, Baghdad Medical City, Baghdad, Iraq.

DOI:

https://doi.org/10.22317/jcms.v6i6.851

Keywords:

Favism, G6PD deficiency, severe haemolysis, Iraqi children

Abstract

Objectives:  This study aimed to assess the demographic, clinical and biochemical characteristics as predictors of haemolysis after ingesting fava beans.

Methods: A cross-sectional study was undertaken. A total of 57 patients with G6PD deficiency were recruited from the Emergency Department of Children Welfare Teaching Hospital, Medical City. Data were collected using a specially designed form. A purposive sampling method was used to recruit 57 patients 49 males and 8 females who were visiting the pediatric emergency department from March to May 2017 with a presentation of acute hemolytic episode of G6PD. Patients were classified into mild or severe haemolysis groups based on their haemoglobin level at the time of admission.

Results: Younger age group patients tend to present with the severe form of hemolysis (3.59 years with a P value of 0.001). No significant gender susceptibility between both types of hemolysis. The urban area based living individuals tend to present with mild hemolysis while those from rural areas tends to present with more severe episodes of hemolysis (P value 0.001). There was a significant correlation between the type of fava bean ingestion (fresh or dried) and the severity of hemolysis, those who presented with more severe hemolysis usually had a history of ingestion of fresh type of fava bean. Eight individuals of severe type recorded previous episodes of hemolysis while three individuals of the mild type recorded previous episodes (P value 0.001). Family history of G6PD was significant in 88.2% of individuals with the severe form (P value 0.005).

Conclusions: This study is aimed to report several factors that might predict the severity of hemolysis among patients with G6PD deficiency. Younger age, residence in a rural region, ingestion of fresh fava beans, and history of frequent hemolysis incidents are predictors of developing severe hemolysis among children admitted to the emergency room of Children Welfare Teaching Hospital in Medical City/Baghdad.

References

1. Cappellini MD, Fiorelli G. Glucose-6-phosphate dehydrogenase deficiency. Lancet (London, England), 2008; 371(9606):64-74.
2. Nkhoma ET, Poole C, Vannappagari V, Hall SA, Beutler E. The global prevalence of glucose-6-phosphate dehydrogenase deficiency: A systematic review and meta-analysis. Blood Cells, Molecules, and Diseases, 2009; 42(3):267-278.
3. Al-Musawi BM, Al-Allawi N, Abdul-Majeed BA, Eissa AA, Jubrael JM, Hamamy H. Molecular characterization of glucose-6-phosphate dehydrogenase deficient variants in Baghdad city - Iraq. BMC blood disorders.2012;12:4.
4. Al-Musawi, B.M., Al-Allawi N., Abdul-Majeed, B.A. et al. Molecular characterization of glucose-6-phosphate dehydrogenase deficient variants in Baghdad city - Iraq. BMC Hematol,2012; 12, 4.
5. Merdin A, Avci F, Guzelay N,Glucose-6-phosphate dehydrogenase deficiency presented with convulsion: a rare case. Hematology reports, 2014; 6 (1):5266.
6. Frank JE. Diagnosis and management of G6PD deficiency. American family physician, 2005; 72(7):1277-1282.
7. World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects , JAMA, 2013;310(20):2191-2194
8. Al-Sweedan SA, Jdaitawi H, Khriesat WM, Khader YY, Al-Rimawi HS. Predictors of severe hemolysis in patients with glucose-6-phosphate dehydrogenase deficiency following exposure to oxidant stresses. Hematology/Oncology and Stem Cell Therapy,2009;2 (2):354-357.
9. Yao LQ, Zou TB, Wang XT, Quan X, Chen Q, Yang FB, Hu LS, Fan LM, Wang M, Feng XY, Liu JT, Zhao ZM [G6PD deficiency among children under 7 years old from Yunnan with unique ethnic minority origin]. Chinese journal of medical genetics,2013; 30 (2):189-194.
10. Von Fricken ME, Weppelmann TA, Eaton WT, Alam MT, Carter TE, Schick L, Masse R, Romain JR, Okech BA ,Prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency in the Ouest and Sud-Est departments of Haiti. Actatropica ,2014;135:62-66.
11. Ntaios G, Chatzinikolaou A, Tomos C, Manolopoulos C, Karalazou P, Nikolaidou A, Alexiou-Daniel S, Prevalence of glucose-6-phosphate dehydrogenase deficiency in Northern Greece. Internal medicine journal,2008; 38 (3):204-206.
12. Guindo A, Fairhurst RM, Doumbo OK, Wellems TE, Diallo DA ,X-linked G6PD deficiency protects hemizygous males but not heterozygous females against severe malaria. PLoS medicine,2007; 4 (3):66
13. Sultan AS ,Medicine in the 21st century: the situation in a rural Iraqi community. Patient education and counseling,2007; 68 (1):66-69.
14. Belsey MA (1973) The epidemiology of favism. Bulletin of the World Health Organization 48 (1):1-13
15. Kattamis CA, Kyriazakou M, Chaidas S (1969) Favism: clinical and biochemical data. Journal of Medical Genetics 6 (1):34-41.
16. Glucose-6-phosphate dehydrogenase deficiency. WHO Working Group (1989). Bulletin of the World Health Organization 67 (6):601-611
17. Roche SP, Kobos R, Jaundice in the adult patient. American family physician,2004; 69 (2):299-304
18. Tabbara IA Hemolytic anemias. Diagnosis and management. The Medical clinics of North America,1992; 76 (3):649-668
19. Gilmer PR, Jr., Koepke JA ,The reticulocyte. An approach to definition. American journal of clinical pathology,1976;66(1):262-267
20. Catania JA, Dolcini MM, Orellana R, Narayanan V, Nonprobability and probability-based sampling strategies in sexual science. Journal of sex research, 2015;52 (4):396-411.

Downloads

Published

2020-12-26

How to Cite

Ghali, H. H., & Al Mamoori, D. A. (2020). Hemolysis in children with Glucose-6-Phosphate Dehydrogenase deficiency after ingestion of fava beans; facts predicting severity. Journal of Contemporary Medical Sciences, 6(6), 262–266. https://doi.org/10.22317/jcms.v6i6.851