Hemoglobin Droping ...HELP NEEDED NOW!

John Ladasky jladasky at cmgm.Stanford.EDU
Tue Dec 23 17:30:00 EST 1997


In article <uthman-2212971838080001 at tigger-ppp-port-59.neosoft.com>,
Ed Uthman <uthman at neosoft.com> wrote:
>In article <349F3F99.22129DDD at khor.pc.my>, Jordan Khor <kck at khor.pc.my> wrote:
>
>> This is concerning a baby boy borned about 3 weeks ago. At first, he is
>> having jaundice for about 10 days. Now the blood analysis review that
>> the hemoglobin drops continuosly. Also the PCV, TWBC & platelets also
>> droping. He is now in hospital and the Drs have not identified the
>> cause. A bone marrow test will be done on 23 Dec. 1997, 8 am.
>> 
>> There is a case history for the baby's mother. First term baby girl also
>> have some kind of blood related problems and survived only 35days.
>> Second pregnancy ended abruptly in 35-week of gestation. Details are
>> available if required.
>
>I assume from the poster's address that this is happening in Malaysia. I
>believe the Burmese, Thais, Khmer, and other southeast Asian peoples have
>a particularly high incidence of alpha-thalassemia, which could possibly
>account for such a familial presentation of severe neonatal anemia.
>However, the classic cases of homozygous alpha-thal-1 generally are fatal
>within a few hours of birth (or even before birth). Whether a double
>haplozygote alpha-1/alpha-2 could produce this picture I don't know. One
>can rule this out by looking for Hb Bart's by hemoglobin electrophoresis

	Also consider glucose-6-phosphate dehydrogenase (G6PD) deficiency.
G6PD deficiencies are common in SE Asia, as are the thalassemias.  There
is chronic neonatal jaundice in some cases, and it may be induced by in-
fections or by the administration of certain drugs.  The fact that a pre-
vious female child experienced difficulties makes G6PD an unlikely hypo-
thesis, however.  In the first place, the G6PD gene is X-linked, which
means that boys are much more likely to experience trouble than girls.
Second, all the known mutations are recessive, which would mean that in a
female child the normal copy of the X chromosome should compensate for the
mutated one.  Still, it's worth considering.  Maybe the father's G6PD 
and/or hemoglobin status should be checked, too.

-- 
Rainforest laid low.
"Wake up and smell the ozone,"
Says man with chainsaw.					- John Ladasky



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