A case of depression with psychotic features associated with hemoglobin Manukau mutation

It is pertinent to investigate organic possibilities in acute presentation of mental illness. Iron-deficiency anemia has long been established to cause symptoms of major depressive disorder. The association between depression and hemolytic anemia and hemochromatosis is less understood.

A rare type of hemolytic anemia caused by hemoglobin (Hb) Manukau is reported in a 30-year-old female presenting with 3 weeks of severe depression, paranoia, auditory hallucinations, and suicidal ideation. The client was admitted to a psychiatric unit and received treatment with sertraline and olanzapine. Post-discharge follow up is with a community mental health team. The psychiatric history includes recurrent episodes of major depression with psychotic features, with the first occurring after a stillbirth at age 18 years. The treatment history includes electroconvulsive therapy, sertraline, and olanzapine. The medical complications of the Hb Manukau are chronic hemolytic anemia, liver disease, and hemochromatosis, requiring frequent blood transfusions and iron chelation therapy.

This rare hemoglobinopathy may contribute to the pathogenesis of recurrent depression with psychotic features, potentially through iron deposition in the brain or by other mechanisms yet to be defined.