Multidisciplinary approach to screening and management of children with Fabry disease: practice at a Tertiary Children’s Hospital in China

Orphanet Journal of Rare Diseases

Jianshe Wang¹  Bingbing Wu²  Wenhao Zhou³  Liuhui Wang⁴  Wei Lu⁵  Ying Huang⁶  Yun Cao⁷  Hong Xu⁸  Qian Shen⁸  Jing Chen⁸  Jialu Liu⁸  Yi Wang⁹  Lifei Yu⁹  Shuizheng Zhou⁹  Chenhao Yang^1,10  Zhengmin Xu^1,11  Yangyang Ma^1,12  Daqian Zhu^1,13  Li Sun^1,14  Lili Fu^1,15  Fang Liu^1,16 

[1] Center for Pediatric Liver Diseases, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China;Clinical Genetic Center, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China;Clinical Genetic Center, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China;Department of Neonatology, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China;Department of Dermatology, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China;Department of Endocrinology and Inherited Metabolic Diseases, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China;Department of Gastroenterology, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China;Department of Neonatology, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China;Department of Nephrology, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China;Department of Neurology, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China;Department of Ophthalmology, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China;Department of Otolaryngology-Head and Neck Surgery, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China;Department of Pathology, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China;Department of Psychology, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China;Department of Rheumatology, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China;Department of Social Work, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China;Pediatric Heart Center, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China;

关键词: Fabry disease;    Multidisciplinary team;    Rare disease;    Screening;    Dried blood spot;    Enzyme replacement therapy;    Children;   

DOI  :  10.1186/s13023-021-02136-1

来源: Springer

【 摘 要 】

BackgroundFabry disease (FD) remains poorly recognized, especially in children in China. Considering the diversity and nonspecific clinical manifestations accompanying with life-threatening aspect of this disease, methods to improve effective screening and management of the suspects are needed. This study aims to explore how it can be done effectively from a multidisciplinary perspective for children with FD at a tertiary children’s hospital in China.MethodsA multidisciplinary team (MDT) of pediatric FD experts was launched at Children’s Hospital of Fudan University. Children with high-risk characteristics were referred by the MDT screening team using the dried blood spot (DBS) triple-test (α-galactosidase A, globotriaosylsphingosine, GLA gene). For newborns who were undergoing genetic testing in the hospital, the GLA gene was listed as a routine analysis gene. Evaluation, family screening, and genetic counselling were implemented after screening by the MDT management team.ResultsBefore the establishment of the MDT, no case was diagnosed with FD in the hospital. However, twelve months following the MDT program's implementation, thirty-five children with high-risk profiles were referred for screening by DBS triple-test, with a yield of diagnosis of 14.3% (5/35). These 5 diagnosed children were referred due to a high-risk profile of pain accompanied by dermatological angiokeratoma and hypohidrosis (n = 2), pain accompanied by abnormal liver function (n = 1), pain only (n = 1), and unexplained renal tubular dysfunction (n = 1). Two neonates were detected early with GLA mutations in the hospital, with a yield of detection of 0.14% (2/1420). Furthermore, another 3 children diagnosed with FD were referred from other hospitals. Family screening of these 10 diagnosed children indicated that 9 boys inherited it from their mothers and 1 girl inherited it from her father. Four of them started to receive enzyme replacement therapy.ConclusionScreening and management of children with FD is effective based on a defined screening protocol and a multidisciplinary approach. We should pay more attention to the high-risk profiles of pain, angiokeratoma, decreased sweating, and unexplained chronic kidney disease in children.

【 授权许可】

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