How we manage patients with pyruvate kinase deficiency

Rachael F. Grace, D. Mark Layton, Wilma Barcellini

Research output: Contribution to journalReview article

Abstract

Novel therapies in development have brought a new focus on pyruvate kinase deficiency (PKD), the most common congenital haemolytic anaemia due to a glycolytic enzyme deficiency. With an improved recognition of its clinical presentation and understanding of the diagnostic pathway, more patients are likely to be identified with this anaemia. Complications, including gallstones and non-transfusion-related iron overload, require monitoring for early diagnosis and management. Current management remains supportive with red cell transfusions, chelation and splenectomy. Decisions to transfuse and/or splenectomise must be individualised. Haematopoietic stem cell transplant has been pursued in a small number of patients with mixed outcomes. Novel treatment approaches, which range from a small molecule pyruvate kinase activator to gene therapy, may transform the way in which PKD is managed in the future. In this review, we discuss the pathophysiology of PKD and present our approaches to diagnosis, monitoring and management of patients with this anaemia.

Original languageEnglish
Pages (from-to)721-734
Number of pages14
JournalBritish Journal of Haematology
Volume184
Issue number5
DOIs
Publication statusPublished - Mar 1 2019

Keywords

  • congenital haemolytic anaemia
  • iron overload
  • Pyruvate kinase deficiency
  • splenectomy
  • transfusions

ASJC Scopus subject areas

  • Hematology

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