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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 |
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| container_end_page | 476 |
| container_issue | 2 |
| container_start_page | 473 |
| container_title | Pediatric nephrology (Berlin, West) |
| container_volume | 36 |
| creator | Searcy, Kristie Rainwater, Sarah Jeroudi, Majed Baliga, Radhakrishna |
| description | 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. |
| doi_str_mv | 10.1007/s00467-020-04810-1 |
| format | article |
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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.</description><identifier>ISSN: 0931-041X</identifier><identifier>EISSN: 1432-198X</identifier><identifier>DOI: 10.1007/s00467-020-04810-1</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>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</subject><ispartof>Pediatric nephrology (Berlin, West), 2021-02, Vol.36 (2), p.473-476</ispartof><rights>IPNA 2020</rights><rights>IPNA 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c2671-383660b7da9632e8038227f0956ba2c202b0a245e60e6770f220ae077050769a3</citedby><cites>FETCH-LOGICAL-c2671-383660b7da9632e8038227f0956ba2c202b0a245e60e6770f220ae077050769a3</cites><orcidid>0000-0002-3978-3060</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids></links><search><creatorcontrib>Searcy, Kristie</creatorcontrib><creatorcontrib>Rainwater, Sarah</creatorcontrib><creatorcontrib>Jeroudi, Majed</creatorcontrib><creatorcontrib>Baliga, Radhakrishna</creatorcontrib><title>Erythropoietin-stimulating agent-resistant vitamin B6 deficiency anemia in a pediatric patient on hemodialysis</title><title>Pediatric nephrology (Berlin, West)</title><addtitle>Pediatr Nephrol</addtitle><description>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.</description><subject>Anemia</subject><subject>Biopsy</subject><subject>Blood transfusion</subject><subject>Blood transfusions</subject><subject>Bone marrow</subject><subject>Brief Report</subject><subject>Erythropoietin</subject><subject>Ferritin</subject><subject>Heme</subject><subject>Hemodialysis</subject><subject>Hemoglobin</subject><subject>Hyperplasia</subject><subject>Iron</subject><subject>Kidney diseases</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Nephrology</subject><subject>Nutrient deficiency</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Protoporphyrin</subject><subject>Reticulocytes</subject><subject>Transferrin</subject><subject>Urology</subject><subject>Vitamin B6</subject><subject>What's New in Dialysis</subject><issn>0931-041X</issn><issn>1432-198X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kcFqGzEQhkVooa6TF8hJ0EsvSkdar6Q9JsZJCoZeGvBNyOtZW2ZXu5Xkgt--0zgQ6KEnDaPv-xn4GbuVcCcBzLcMsNBGgAIBCytByCs2k4tKCdnYzQc2g6aS9CU3n9jnnI8AYGurZyyu0rkc0jiNAUuIIpcwnHpP4577PcYiEuaQi4-F_w7FDyHyB8132IU2YGzP3Eccgue093zCXfAlhZZPFEE2HyM_4DDSuj9TzjX72Pk-483bO2cvj6ufy2ex_vH0fXm_Fq3SRorKVlrD1ux8oyuFFiqrlOmgqfXWq1aB2oJXixo1oDYGOqXAI9BUg9GNr-bs6yV3SuOvE-bihpBb7Hu6djxlRy6F6qapCf3yD3ocTynSdUQZa7XVjSJKXag2jTkn7NyUwuDT2UlwfytwlwocVeBeK3CSpOoiZYLjHtN79H-sP1BIiSY</recordid><startdate>20210201</startdate><enddate>20210201</enddate><creator>Searcy, Kristie</creator><creator>Rainwater, Sarah</creator><creator>Jeroudi, Majed</creator><creator>Baliga, Radhakrishna</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-3978-3060</orcidid></search><sort><creationdate>20210201</creationdate><title>Erythropoietin-stimulating agent-resistant vitamin B6 deficiency anemia in a pediatric patient on hemodialysis</title><author>Searcy, Kristie ; Rainwater, Sarah ; Jeroudi, Majed ; Baliga, Radhakrishna</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2671-383660b7da9632e8038227f0956ba2c202b0a245e60e6770f220ae077050769a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Anemia</topic><topic>Biopsy</topic><topic>Blood transfusion</topic><topic>Blood transfusions</topic><topic>Bone marrow</topic><topic>Brief Report</topic><topic>Erythropoietin</topic><topic>Ferritin</topic><topic>Heme</topic><topic>Hemodialysis</topic><topic>Hemoglobin</topic><topic>Hyperplasia</topic><topic>Iron</topic><topic>Kidney diseases</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Nephrology</topic><topic>Nutrient deficiency</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Protoporphyrin</topic><topic>Reticulocytes</topic><topic>Transferrin</topic><topic>Urology</topic><topic>Vitamin B6</topic><topic>What's New in Dialysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Searcy, Kristie</creatorcontrib><creatorcontrib>Rainwater, Sarah</creatorcontrib><creatorcontrib>Jeroudi, Majed</creatorcontrib><creatorcontrib>Baliga, Radhakrishna</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Nursing and Allied Health Journals</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Family Health Database (Proquest)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric nephrology (Berlin, West)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Searcy, Kristie</au><au>Rainwater, Sarah</au><au>Jeroudi, Majed</au><au>Baliga, Radhakrishna</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Erythropoietin-stimulating agent-resistant vitamin B6 deficiency anemia in a pediatric patient on hemodialysis</atitle><jtitle>Pediatric nephrology (Berlin, West)</jtitle><stitle>Pediatr Nephrol</stitle><date>2021-02-01</date><risdate>2021</risdate><volume>36</volume><issue>2</issue><spage>473</spage><epage>476</epage><pages>473-476</pages><issn>0931-041X</issn><eissn>1432-198X</eissn><abstract>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.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><doi>10.1007/s00467-020-04810-1</doi><tpages>4</tpages><orcidid>https://orcid.org/0000-0002-3978-3060</orcidid></addata></record> |
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| ispartof | Pediatric nephrology (Berlin, West), 2021-02, Vol.36 (2), p.473-476 |
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| language | eng |
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| source | Springer Link |
| 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 |
| title | Erythropoietin-stimulating agent-resistant vitamin B6 deficiency anemia in a pediatric patient on hemodialysis |
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