Erythropoietin-stimulating agent-resistant vitamin B6 deficiency anemia in a pediatric patient on hemodialysis

Background Vitamin B 6 is a rate-limiting coenzyme that plays an important role in the biosynthesis of heme and the incorporation of iron into protoporphyrin. Its deficiency is often seen in chronic kidney disease (CKD), particularly those requiring dialysis and following administration of erythropo...

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Published in:Pediatric nephrology (Berlin, West) West), 2021-02, Vol.36 (2), p.473-476
Main Authors: Searcy, Kristie, Rainwater, Sarah, Jeroudi, Majed, Baliga, Radhakrishna
Format: Article
Language:English
Subjects:
Anemia
Biopsy
Blood transfusion
Blood transfusions
Bone marrow
Brief Report
Erythropoietin
Ferritin
Heme
Hemodialysis
Hemoglobin
Hyperplasia
Iron
Kidney diseases
Medicine
Medicine & Public Health
Nephrology
Nutrient deficiency
Patients
Pediatrics
Protoporphyrin
Reticulocytes
Transferrin
Urology
Vitamin B6
What's New in Dialysis
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Summary:Background Vitamin B 6 is a rate-limiting coenzyme that plays an important role in the biosynthesis of heme and the incorporation of iron into protoporphyrin. Its deficiency is often seen in chronic kidney disease (CKD), particularly those requiring dialysis and following administration of erythropoietin-stimulating agent (ESA). Case- diagnosis/treatment A 16-year-old African-American male with stage 5 CKD on chronic hemodialysis experienced a decrease in hemoglobin over a 3-month period from 11 to 6.5 g/dl while receiving ESA, resulting in multiple blood transfusions. His transferrin saturation was 41%, ferritin level 706 [80–388] ng/mL, mean corpuscular volume (MCV) 87 [78–98] μm 3 , corrected reticulocytes count 2.3% [0.2–1.8%], and vitamin B 6 1.2 [5.3–46.7] μg/L. Bone marrow biopsy was normocellular (65%) with erythroid hyperplasia and rare dyserythropoiesis. Prussian blue staining showed increased iron storage. Supplemental vitamin B 6 (100 mg daily) was initiated at hemoglobin 7.3 g/dL with correction of anemia. Eighteen months later, his hemoglobin is 11.7 g/dL, transferrin saturation 45%, with no additional blood transfusions. Conclusions Vitamin B 6 deficiency anemia should be considered in any pediatric patient on hemodialysis who does not respond to standard ESA and iron therapy.
ISSN:0931-041X
1432-198X
DOI:10.1007/s00467-020-04810-1