Erythropoietin treatment in the neuropsychiatric porphyrias

Winkler, Andrea Sylvia; Marsden, Joanne; Deacon, A C; Chandler, Georgina; Macdougall, Iain C.

doi:10.1016/j.cccn.2003.07.015

Cited by 4 publications

(2 citation statements)

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“…However, in this study, the patient had normocytic and normochromic type of anemia. Thus, our observations suggest that there is a reduction in the number of erythrocytes generated in bone marrow and this assumption agrees with the findings of Winkler et al (2003) who reported that patients with porphyria and showing neuropsychiatric symptoms have low levels of erythropoietin and its use for treatment can reduce attacks.…”

Section: Discussionsupporting

confidence: 92%

Biochemical and hematological analysis in acute intermittent porphyria (AIP): a case report

Santos¹,

Albuquerque²,

Doriqui³

et al. 2013

An. Acad. Bras. Ciênc.

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Acute intermittent porphyria is the most common acute porphyria caused by a decrease in hepatic porphobilinogen deaminase activity, resulting in an accumulation of delta-aminolevulinic acid and porphobilinogen. This disease shows nonspecific signs and symptoms that can be confused with other diseases, thereby making the diagnosis difficult. We report a case of acute intermittent porphyria, reviewing clinical and laboratory aspects, highlighting the hematological and biochemical parameters during and after the crisis. A female patient, aged 28 years, suffered two crises, both presenting gastrointestinal disorders. The second presented neuropsychiatric symptoms. The analysis of hematological and biochemical parameters during the second crisis showed anemia, leukocytosis, hyponatremia, mild hypokalemia, uremia and elevated C-reactive protein. The initial treatment included glucose infusion, a diet rich in carbohydrates and interruption of porphyrinogenic drugs. Subsequently, treatment was maintained with oral contraceptive use. According to the observed data, signs and symptoms of gastrointestinal, neurological and psychiatric disorders, associated with laboratory results presented in this paper can be applied to screen acute porphyria, contributing to early diagnosis.

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Section: Discussionsupporting

confidence: 92%

Biochemical and hematological analysis in acute intermittent porphyria (AIP): a case report

Santos¹,

Albuquerque²,

Doriqui³

et al. 2013

An. Acad. Bras. Ciênc.

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“…Reports, principally from Japan, of the beneficial effect of cimetidine are not well substantiated, and indeed this agent is a cytochrome inducer. 26 A recent report, 27 developing the observation that patients with anaemia have inappropriately low EPO levels, suggests that EPO therapy may be beneficial but there is a need for placebocontrolled trials of this approach. It has long been known that the porphyrin precursors ALA and PBG are produced in the liver -hence the alternative classification of the neuropsychiatric porphyrias as hepatic porphyrias.…”

Section: Treatment Of Acute Attacksmentioning

confidence: 99%

Porphyria for the general physician

Sarkany

2005

Clinical Medicine

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Awareness and consideration are essential in making/suspecting a diagnosis of the acute neuropsychiatric porphyriasAcute porphyria should be considered in the differential diagnosis of hyponatraemia, renal impairment and atypical psychiatric and neurologic disorders Accurate quantitation of porphobilinogen, δ-aminolaevulinate and porphyrins in laboratory samples is essential in confirming a diagnosis Recent developments in treatment and prevention strategies have considerably improved the quality of life of patients with porphyria Molecular genetics are not necessary in initial diagnosis, but are valuable in confirmatory investigations and in family studiesAccurate biochemical diagnosis is crucial in cutaneous porphyria since acute porphyrias (variegate porphyria and hereditary coproporphyria) can cause skin signs indistinguishable from a non-acute porphyria (porphyria cutanea tarda) Porphyria cutanea tarda often reflects underlying liver disease or haemochromatosis Neuropsychiatric featuresThe acute porphyrias are also known as the neuropsychiatric porphyrias due to the neurological and occasional psychiatric features of a severe acute attack. Occasionally, patients with a primarily psychiatric diagnosis are referred for consideration of an underlying porphyria. 7 Because of the stigma associated with a psychiatric diagnosis, patients and their relatives prefer a diagnosis of porphyria to one of a primary psychosis. A careful study by Patience et al 8 indicated that, with the exception of anxiety disorder, schizophrenia, bipolar disorder and simple depression are no more common in the acute porphyrias than in a control population. The basis of the association of chronic anxiety with porphyria is unclear. Some studies consider it secondary to recurrent acute attacks but it is equally common in fully latent cases. The symptoms may be quite disabling and referral for assessment and treatment (eg cognitive behavioural therapy) can be helpful.A recent report has highlighted the important relationship between epilepsy and the acute porphyrias. 9 Screening testsPrevious laboratory screening tests for porphyria were unreliable with false-positive and false-negative rates approaching 50%. 10 More recent semiquantitative tests are more accurate, but a definitive conclusion requires quantitative assay for porphobilinogen (PBG) and δ-aminolaevulinic acid (ALA) in an early morning urine sample. 11 Certain drugs may interfere with screening tests, while assays of PBG alone may be unreliable in aged urine samples, may not reflect the clinical activity of the porphyria, would not identify Doss porphyria (due to PBG synthase defect) and may miss cases of secondary porphyria (eg lead poisoning). Renal complicationsRenal complications of acute porphyria are recognised in the porphyria literature but nephrologists rarely consider them in the differential diagnosis of chronic renal disease. A recent update series on renal failure in this journal failed to mention porphyria. 12 Hypertension and analgesic nephropathy are not infrequ...

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