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Blood, 15 March 2004, Vol. 103, No. 6, pp. 2401-2403.
Prepublished online as a Blood First Edition Paper on November 13, 2003; DOI 10.1182/blood-2003-09-3160.
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RED CELLS Brief report
Hemolytic anemia and severe rhabdomyolysis caused by compound heterozygous mutations of the gene for erythrocyte/muscle isozyme of aldolase, ALDOA(Arg303X/Cys338Tyr)
David C. Yao,
Dean R. Tolan,
Michael F. Murray,
David J. Harris,
Basil T. Darras,
Alon Geva, and
Ellis J. Neufeld
From the Division of Genetics, Department Neurology and the Division of Hematology, Children's Hospital Boston, Dana Farber Cancer Institute, and Harvard Medical School, Boston, MA; the Department of Biology, Boston University; and the Department of Medicine, Brigham and Women's Hospital, Boston, MA.
Aldolase (E.C. 4.1.2.13), a homotetrameric protein encoded by the ALDOA gene, converts fructose-1,6-bisphosphate to dihydroxyacetone phosphate and glyceraldehyde-3-phosphate. Three isozymes are encoded by distinct genes. The sole aldolase present in red blood cells and skeletal muscle is the A isozyme. We report here the case of a girl of Sicilian descent with aldolase A deficiency. Clinical manifestations included transfusion-dependent anemia until splenectomy at age 3 and increasing muscle weakness, with death at age 4 associated with rhabdomyolysis and hyperkalemia. Sequence analysis of the ALDOA coding regions revealed 2 novel heterozygous ALDOA mutations in conserved regions of the protein. The paternal allele encoded a nonsense mutation, Arg303X, in the enzyme-active site. The maternal allele encoded a missense mutation, Cys338Tyr, predicted to cause enzyme instability. This is the most severely affected patient reported to date and only the second with both rhabdomyolysis and hemolysis.

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