Erythropoietin-stimulating agent-resistant vitamin B 6 deficiency anemia in a pediatric patient on hemodialysis

Vitamin B 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-stimula...

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Bibliographic Details
Published in:Pediatric nephrology (Berlin, West) West), 2021-02, Vol.36 (2), p.473
Main Authors: Searcy, Kristie, Rainwater, Sarah, Jeroudi, Majed, Baliga, Radhakrishna
Format: Article
Language:English
Subjects:
Adolescent
Anemia - drug therapy
Anemia - etiology
Anemia, Iron-Deficiency
Child
Epoetin Alfa
Erythropoietin
Hematinics - therapeutic use
Hemoglobins - metabolism
Humans
Iron
Kidney Failure, Chronic - complications
Kidney Failure, Chronic - therapy
Male
Renal Dialysis - adverse effects
Renal Insufficiency, Chronic - complications
Renal Insufficiency, Chronic - therapy
Transferrins
Vitamin B 6
Vitamins
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Summary:Vitamin B 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). 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 , corrected reticulocytes count 2.3% [0.2-1.8%], and vitamin B 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 (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. Vitamin B deficiency anemia should be considered in any pediatric patient on hemodialysis who does not respond to standard ESA and iron therapy.
ISSN:1432-198X
DOI:10.1007/s00467-020-04810-1