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Fava Bean- Versus Non-Fava Bean-Induced Acute Hemolytic Crisis in Children With Glucose-6-Phosphate Dehydrogenase
Gowda Parameshwara Prashanth1, Mohammed Al-Shafey2, Anita Tandon3
1National University of Science & Technology, College of Medicine and Health Sciences, Sohar, Oman.
Insights
Children with Glucose-6-phosphate dehydrogenase (G6PD) deficiency experiencing fava bean-induced hemolysis (FBIH) show more severe acute hemolytic episodes (AHEs) than those with non-fava bean-induced hemolysis (NFBIH). Early risk stratification is possible using clinical and lab markers.
Area of Science:
- Hematology
- Genetics
- Pediatrics
Background:
- Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a common red cell enzymopathy.
- Oxidative stressors, including fava beans, can trigger acute hemolytic episodes (AHEs) in individuals with G6PD deficiency.
Purpose of the Study:
- To compare the clinical characteristics of fava bean-induced hemolysis (FBIH) with non-fava bean-induced hemolysis (NFBIH) in children with G6PD deficiency.
- To identify predictors for severity in AHEs within a high-prevalence setting.
Main Methods:
- A prospective cohort study analyzed hospital records of children hospitalized for AHE due to G6PD deficiency over three years.
- Participants were classified into FBIH and NFBIH groups based on the precipitating factor.
Main Results:
- Fava bean-induced hemolysis (FBIH) accounted for 51.6% of AHEs.
- Children with FBIH were younger, presented more frequently with abdominal pain, and exhibited greater hemolysis severity (lower hemoglobin levels).
- Elevated levels of serum ferritin, blood urea, lactate dehydrogenase, and alkaline phosphatase were observed in the FBIH group.
Conclusions:
- Children with FBIH experience more severe hemolytic episodes than those with NFBIH.
- Clinical and laboratory parameters can aid in early risk stratification for AHEs.
- Culturally sensitive dietary education is crucial, and further research into G6PD genotypes is warranted.
Background:
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a red cell enzymopathy in which exposure to oxidative stressors, such as drugs or fava bean ingestion, can trigger acute hemolytic episodes (AHEs). This study aimed to compare the clinical characteristics of fava bean-induced hemolysis (FBIH) with non-fava bean-induced hemolysis (NFBIH) in children with G6PD deficiency in a high-prevalence setting.
Methods:
A prospective cohort study was conducted at a region referral hospital in Oman. Hospital records of children hospitalized for AHE due to G6PD deficiency over a 3-year period were analyzed. Participants were categorized into FBIH and NFBIH groups based on the documented precipitating factor.
Results:
Among the 236 recruited cases, 51.6% AHEs were attributed to FBIH. Children with FIBH were younger, more likely to present with abdominal pain, and had greater severity of hemolysis upon admission (hemoglobin: 4.8 vs. 6.7 g/dL; p < 0.001). Lab markers such as serum ferritin, blood urea, lactate dehydrogenase, and alkaline phosphatase were significantly elevated in FBIH. The least squares regression model demonstrated a strong link between various predictor variables and hemoglobin levels, explaining about 76.6% of the variance in the study cohort.
Conclusion:
Children with FBIH experience more severe hemolytic episodes compared to those with NFBIH. Our statistical model identified clinical and laboratory parameters potentially useful in early risk stratification during AHEs. Culturally sensitive dietary education of patients and caregivers is necessary, particularly in regions where fava beans are a dietary staple. The potential influence of specific G6PD genotypes within the NFBIH group merits future investigation.
