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Unusual Association of Diamond–Blackfan Anemia and Severe Sinus Bradycardia in a Six-Month-Old White Infant: A Case Report and Literature Review

Authors :
Stefana Maria Moisa
Elena-Lia Spoiala
Laura Mihaela Trandafir
Lacramioara Ionela Butnariu
Ingrith-Crenguta Miron
Antonela Ciobanu
Adriana Mocanu
Anca Ivanov
Carmen Iulia Ciongradi
Ioan Sarbu
Anamaria Ciubara
Carmen Daniela Rusu
Alina Costina Luca
Alexandru Burlacu
Source :
Medicina, Vol 59, Iss 2, p 362 (2023)
Publication Year :
2023
Publisher :
MDPI AG, 2023.

Abstract

Diamond–Blackfan anemia is a rare (6–7 million live births), inherited condition manifesting as severe anemia due to the impaired bone marrow production of red blood cells. We present the unusual case of a six month old infant with a de novo mutation of the RPS19 gene causing Diamond–Blackfan anemia who additionally suffers from severe sinus bradycardia. The infant was diagnosed with this condition at the age of four months; at the age of 6 months, she presents with severe anemia causing hypoxia which, in turn, caused severe dyspnea and polypnea, which had mixed causes (hypoxic and infectious) as the child was febrile. After correction of the overlapping diarrhea, metabolic acidosis, and severe anemia (hemoglobin < 3 g/dL), she developed severe persistent sinus bradycardia immediately after mild sedation (before central venous catheter insertion), not attributable to any of the more frequent causes, with a heart rate as low as 49 beats/min on 24 h Holter monitoring, less than the first percentile for age, but with a regular QT interval and no arrhythmia. The echocardiogram was unremarkable, showing a small interatrial communication (patent foramen ovale with left-to-right shunting), mild left ventricular hypertrophy, normal systolic and diastolic function, and mild tricuspid regurgitation. After red cell transfusion and appropriate antibiotic and supportive treatment, the child’s general condition improved dramatically but the sinus bradycardia persisted. We consider this a case of well-tolerated sinus bradycardia and foresee a good cardiologic prognosis, while the hematologic prognosis remains determined by future corticoid response, treatment-related complications and risk of leukemia.

Details

Language :
English
ISSN :
16489144 and 1010660X
Volume :
59
Issue :
2
Database :
Directory of Open Access Journals
Journal :
Medicina
Publication Type :
Academic Journal
Accession number :
edsdoj.46cf09496f74c4c89a4e59eab18eb32
Document Type :
article
Full Text :
https://doi.org/10.3390/medicina59020362