Abstract
Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a
common X-linked enzyme disorder associated with hemolytic anemia after
exposure to certain medications or foods. Activity testing is the gold
standard for detecting G6PD deficiency; however, this test is affected
by various hematologic parameters. Clinical G6PD genotyping is included
in pharmacogenetic arrays and clinical sequencing and may be reconciled
with activity results. Methods: Patients (n=1,391) enrolled on an
institutional pharmacogenetic testing protocol underwent clinical G6PD
genotyping for 164 G6PD variants. For the 446 patients with G6PD
activity results, algorithms were designed to assign G6PD status,
accounting for known interferences with the activity assay and for G6PD
genotype results. We developed clinical decision support alerts to
inform prescribers when high-risk medications were prescribed, warning
of gene-drug interactions and recommending therapy alteration. Results:
Of 1,391 patients with genotype, 1,334 (95.9%) patients were predicted
to have normal G6PD activity, 30 (2.1%) were predicted to have variable
G6PD activity, and 27 (2%) were predicted to have deficient G6PD
activity. Of the 417 patients with a normal genotype and an activity
result, 415 (99.5%) had a concordant normal G6PD phenotype. Of the 21
patients with a deficient genotype and an activity result, 18 (85.7%)
had a concordant deficient activity result. Genotyping reassigned
phenotype in 5 patients with discordant genotype and activity results: 3
switched from normal to deficient, and 2 switched from deficient to
normal. Conclusion: G6PD activity and genotyping are two independent
testing methods which can be used in conjunction to assign a more
informed G6PD phenotype.