[Pyrimidine 5'-nucleotidase deficiency as the congenital cause of nonspherocytic hemolytic anemia]

Abstract

An 11-year-old girl had marked haemolytic anaemia since the first year of life. Physical examination revealed scleral and cutaneous icterus and slight splenomegaly. Haemoglobin concentration was reduced to 9.5 g/dl, while platelet count and bilirubin concentration were increased (350,000/microliter and 2.2 mg/dl, respectively). The erythrocytes showed marked basophilic stippling, its extent typical of pyrimidine-5'-nucleotidase deficiency. The enzyme activity in the erythrocytes was 15% of normal. Deficiency of this enzyme, inherited as an autosomal recessive, is probably one of the most common erythrocyte enzyme deficiencies causing haemolytic anaemia. It brings about the intracellular accumulation of pyrimidine nucleotides which via secondary metabolic changes causes an accelerated destruction of erythrocytes. There is no known causative treatment: splenectomy is ineffective against the anaemia.