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present at birth but not necessarily hereditary; acquired during fetal development (同)inborn, innate
a deficiency of red blood cells (同)anaemia
a lack of vitality (同)anaemia
genus of terrestrial or lithophytic ferns having pinnatifid fronds; chiefly of tropical America (同)genus Anemia

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(病気・身体的欠陥など)生まれつきの,先天的な

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/07/10 02:36:53」(JST)

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Congenital dyserythropoietic anemia (CDA) is a rare blood disorder, similar to the thalassemias. CDA is one of many types of anemia, characterized by ineffective erythropoiesis, and resulting from a decrease in the number of red blood cells (RBCs) in the body and a less than normal quantity of hemoglobin in the blood. This shortage prevents the blood from carrying an adequate supply of oxygen to the body's tissues, resulting in various symptoms of anemia including: tiredness (fatigue), weakness, pale skin, and other similar complications.^[1]

Genetics[edit]

CDA is transmitted by both parents autosomal recessively (although CDA type III appears to have an autosomal dominant pattern of inheritance^[2]) and has over four different subtypes, but CDA Type I, CDA Type II, CDA Type III, and CDA Type IV are the most common. CDA type II (CDA II) is the most frequent type of congenital dyserythropoietic anemias. More than 200 cases have been described, but with the exception of a report by the International CDA II Registry, these reports include only small numbers of cases and no data on the lifetime evolution of the disease.^[3]

Types include:

Type	OMIM	Gene	Locus
CDAN1	224120	CDAN1	15q15
CDAN2	224100	SEC23B	20p11.2
CDAN3	105600	CDAN3	15q21
CDAN4	613673	KLF1	19p13.13-p13.12

Treatment[edit]

Patients with CDA typically get frequent blood transfusions, but this can vary depending on the type that is acquired. Patients report going every 3–5 weeks for blood transfusions, and receive somewhere between 1-2 adult units of blood (3-4 child units for children). In addition, they must undertake chelation therapy to survive; either deferoxamine (i.e. Desferal), deferasirox (i.e. Exjade, Asunra), or deferiprone (i.e. Kelfer, Ferriprox, L1) to eliminate the excess iron that accumulates. In a clinical sense, the disorder is very similar to thalassemia major (Beta-thalassemia) and treated in the same fashion. Removal of the spleen and gallbladder are common, and problems with the liver and heart become increasingly important as the individual ages, due to stresses from low hemoglobin counts and high iron content. Hemoglobin levels can run anywhere between 6.0 gm/dl and 8.0 gm/dl in untransfused patients, and between 8.0 gm/dl and 10.0 gm/dl in well transfused patients. It is important to go regularly for transfusions and to chelate daily in order to maximize good health.

Exjade, an oral chelator approved by the FDA in November 2005, has made chelation therapy much easier for patients, who previously could only chelate subcutaneously. Deferiprone, another oral chelator, was also recently approved by the FDA on October 14, 2011.^[4] While normal ferritin levels run anywhere between 24 and 336 ng/ml, hematologists generally do not begin chelation therapy until ferritin levels reach at least 1000 ng/ml. It is more important to check iron levels in the organs through annual MRI scans (T2* for the heart, R2 for the liver), however, than to simply get regular blood tests to check ferritin levels (which only show you a trend, and do not reflect actual organ iron content).

Curative Options[edit]

Bone marrow transplant and gene therapy are the only known cures for the disorder, but each have their own risks at this point in time. Bone marrow transplantation is the more established cure, as it has been proven to work in human subjects (whereas researchers are still trying to definitively establish this with gene therapy). It generally requires a 10/10 HLA matched donor, however, who is usually a sibling. As most patients do not have this, they must rely on gene therapy research to potentially provide them with a cure. Gene therapy is still experimental and has largely only been tested in animal models until now. This type of therapy is especially promising, however, as it allows for the autologous transplantation of the patient's own healthy stem cells rather than requiring an outside donor, thereby bypassing any potential for graft vs. host disease (GVHD). Clinical trials on one 18 year old boy in France in 2007 have suggested that he is cured of Beta-thalassemia three years later with no complications noted so far.^[5] A second trial on another patient in France is due to occur sometime by the year 2016.^[6] In the United States, the FDA approved clinical trials on Beta thalassemia patients in 2012. The first study, which takes place at Memorial Sloan Kettering Cancer Center in New York, has begun recruiting human subjects with thalassemia major in July 2012.^[7] The study is set to end in 2014.^[8]

References[edit]

^ http://ghr.nlm.nih.gov/condition/congenital-dyserythropoietic-anemia
^ http://ghr.nlm.nih.gov/condition/congenital-dyserythropoietic-anemia
^ http://bloodjournal.hematologylibrary.org/cgi/content/abstract/102/13/4576
^ http://www.medscape.com/viewarticle/751573
^ http://www.medscape.com/viewarticle/728656
^ http://www.youtube.com/watch?v=eix2m1KDHS4
^ http://www.mskcc.org/blog/launch-stem-cell-therapy-trial-offers-hope-patients-inherited-blood-disorder
^ http://clinicaltrials.gov/ct2/show/NCT01639690?term=lentiviral+thalassemia&rank=1

External links[edit]

Delaunay entry on Congenital Dyserythropoietic Anemia
Congenital dyserythropoietic anemia at the US National Institutes of Health Home Genetic Reference
Gene Therapy Trial Article
Rare Anemias Foundation (RAF)

UpToDate Contents

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1. 小児における赤血球産生低下による貧血 anemia in children due to decreased red blood cell production
2. 貧血を有する成人患者に対するアプローチ approach to the adult patient with anemia
3. 鉄芽球性貧血の病態生理 pathophysiology of the sideroblastic anemias
4. 赤血球産生調節 regulation of erythropoiesis
5. 赤血球の子宮内胎児輸血 intrauterine fetal transfusion of red cells

English Journal

Antiphospholipid syndrome in a patient suffering from congenital dyserythropoietic anemia type III.

Carreno-Tarragona G1, Trapiello-Valbuena F, Aranda-Salom J, Martínez-López J, Lumbreras C, Oliveira-Ramírez E, Díaz-Pedroche C.
Annals of hematology.Ann Hematol.2015 Aug;94(8):1411-2. doi: 10.1007/s00277-015-2379-y. Epub 2015 Apr 22.
PMID 25900788

Homozygosity mapping reveals founder SEC23B-Y462C mutations in Indian congenital dyserythropoietic anemia type II.

Singleton B1, Bansal D2, Varma N3, Das R3, Naseem S3, Saikia UN4, Malhotra P5, Varma S5, Marwaha RK2, King MJ6, Ahmed M7.
Clinical genetics.Clin Genet.2015 Aug;88(2):195-7. doi: 10.1111/cge.12527. Epub 2014 Nov 22.
PMID 25418799

Congenital erythropoietic porphyria linked to GATA1-R216W mutation: challenges for diagnosis.

Di Pierro E1, Russo R2,3, Karakas Z4, Brancaleoni V1, Gambale A2,3, Kurt I5, Winter SS6, Granata F1, Czuchlewski DR7, Langella C2,3, Iolascon A2,3, Cappellini MD1,8.
European journal of haematology.Eur J Haematol.2015 Jun;94(6):491-7. doi: 10.1111/ejh.12452. Epub 2014 Oct 25.
Congenital erythropoietic porphyria (CEP) is a rare genetic disease that is characterized by a severe cutaneous photosensitivity causing unrecoverable deformities, chronic hemolytic anemia requiring blood transfusion program, and by fatal systemic complications. A correct and early diagnosis is requ
PMID 25251786

Japanese Journal

Congenital dyserythropoietic anemia

KAMIYA Takahiro,MANABE Atsushi
International journal of hematology 92(3), 432-438, 2010-10-15
NAID 10027673299

Congenital Dyserythropoietic Anemia の全国調査

多賀崇,伊藤剛,浅見恵子,井上雅美,吉益哲,菊地陽,杉田憲一,鈴木信寛,真部淳,岩崎史記,小阪嘉之,右田昌宏,小原明
日本小児血液学会雑誌 22(4), 233-238, 2008-08-31
NAID 10029309504

Congenital Dyserythropoietic Anemia の全国調査

多賀崇
日小血会誌 22, 233-238, 2008
NAID 50006874835

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★リンクテーブル★

リンク元	「HEMPAS」「先天性赤血球異形成貧血」「hereditary erythroblast multinuclearity with positive acidified serum」
関連記事	「congenita」「dyserythropoietic」「congenital」