Complexities of genetic diagnosis illustrated by an atypical case of congenital hypoplastic anemia.

Diamond-Blackfan Anemia (DBA) is a rare polygenic disorder defined by congenital hypoplastic anemia with marked decrease or absence of bone marrow erythroid precursors. Identifying the specific genetic etiology is important for counseling and clinical management. A 6-yr-old boy with a clinical diagnosis of DBA has been followed by our pediatric hematology team since birth. His clinical course includes transfusion-dependent hypoplastic anemia and progressive autoimmune cytopenias. Genetic testing failed to identify a causative mutation in any of the classical DBA-associated genes. He and his parents underwent trio whole-exome sequencing (WES) with no genetic etiology identified initially. Clinical persistence and suspicion led to testing for adenosine deaminase 2 (ADA2) activity and whole-genome sequencing (WGS) that identified compound heterozygous pathogenic mutations in the ADA2-encoding CECR1 gene, a recently appreciated etiology for congenital hypoplastic anemia. This case illustrates current challenges in genetic testing and how they can be overcome by multidisciplinary expertise in clinical medicine and genomics.

Anemia de Blackfan-Diamond. Presentación de un caso y revisión de la literatura / Blackfan-Diamond Anemia. A case report and review of the literature

La aplasia congénita de la serie roja es una rara causa de anemia hipoplásica congénita, generalmente secundaria a una mutación esporádica. Por su amplio espectro de presentación puede ser de difícil diagnóstico, aunque está descrito un fenotipo característico. La corticolterapia produce la remisión completa en un gran porcentaje de estos pacientes. La ausencia de repuesta a ésta plantea la realización de un trasplante alogénico de médula de dónate HLA idéntico, preferentemente familiar. Si no se dispone de donante adecuado es preciso aplicar una terapia sustitutiva con transfusiones. La hemosiderosis secundaria puede causar una gran morbimortalidad. Nuevas terapias inmunosupresoras con resultados diversos y el uso de la quelación oral podrían cambiar el pronóstico de forma importante. Presentamos, una paciente de diagnóstico precoz, en la que se evidenció una mutación esporádica, resistente a los tratamientos convencionales y no convencionales que, gracias a la quelación oral, ha mejorado radicalmente sus cifras de ferritina, evitando las complicaciones de la hemosiderosis. Actualmente está en espera para acceder a un programa de fertilización para selección embrionaria de posible donante, ya que no posee donante familiar histocompatible (AU)

Congenital aplasia of the red cell series is a rare cause of congenital hypoplastic anemia, generally secondary to sporadic mutation. Due to its wide presentation spectrum, it may be difficult to diagnose, although a characteristic phenotype is described. Corticosteroid therapy may produce complete remission in a large percentage of these patients. Lack of response to it suggests the performance of an allergenic bone marrow transplant form an identical HLA donor, preferably a relative. If no adequate donor is available, substitution treatment must be given with transfusions. Secondary hemosiderosis may cause great morbidity-mortality. New immunosuppressant therapies with different results and the use of oral chelation may change the prognosis significantly. We present the case of a patient with early diagnosis in whom sporadic mutation was observed that was resistant to conventional and non-conventional treatments. Thanks to oral chelation, her ferritin values have radically improved, thus avoiding the complications of hemosiderosis. At present, she is waiting to access a fertilization program for embrionary selection of a possible donor, since she has no histocompatible family donor (AU)

Differential diagnosis and management of anemia in the newborn.

Neonatal anemia is a condition with a diverse etiologic spectrum.Therefore, in order to form a focused differential diagnosis, it is important for the caregiver to have some knowledge of the more common causes of low hemoglobin and hematocrit concentrations in the neonate. Proper history taking, physical examination, and interpretation of diagnostic tests can narrow this focus and aid in establishing an accurate diagnosis and in directing the appropriate therapeutic interventions.