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{{Fanconi anemia}}
{{Fanconi anemia}}


{{CMG}}
{{CMG}} {{AE}} {{shyam}}


{{SK}} Fanconi anaemia; Fanconi hypoplastic anemia; Fanconi panmyelopathy; Fanconi pancytopenia; FA
{{SK}} Fanconi anaemia; Fanconi hypoplastic anemia; Fanconi panmyelopathy; Fanconi pancytopenia; FA


==[[Fanconi anemia overview|Overview]]==
==[[Fanconi anemia overview|Overview]]==
'''Fanconi anemia''' (FA) is a [[Genetic disorder|genetic disease]] that affects children and adults from all ethnic backgrounds. The disease is named after the Swiss pediatrician who originally described this disorder, [[Guido Fanconi]]. FA is characterized by [[short stature]], skeletal anomalies, increased incidence of solid tumors and leukemias, bone marrow failure ([[aplastic anemia]]), and cellular sensitivity to DNA damaging agents such as [[Mitomycin|mitomycin C]].
==[[Fanconi anemia historical perspective|Historical Perspective]]==


==[[Fanconi anemia historical perspective|Historical Perspective]]==
==[[Fanconi anemia classification|Classification]]==
The discovery of fanconi anemia is largely the work of Swiss pediatrician Guido Fanconi who observed various finding of fanconi anemia to be different then pernicious anemia and led to its discovery.


==[[Fanconi anemia pathophysiology|Pathophysiology]]==
==[[Fanconi anemia pathophysiology|Pathophysiology]]==
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==[[Fanconi anemia causes|Causes]]==
==[[Fanconi anemia causes|Causes]]==


There are at least 13 genes of which mutations are known to cause FA.
==[[Fanconi anemia differential diagnosis|Differentiating Fanconi Anemia from Other Diseases]]==


=== Common Genes[edit | edit source] ===
==[[Fanconi anemia epidemiology and demographics|Epidemiology and Demographics]]==
* FANCA, FANCB, FANCC, FANCD1 (BRCA2).
* FANCD2, FANCE, FANCF FANCG.


==[[Fanconi anemia differential diagnosis|Differentiating Fanconi anemia from other Diseases]]==
==[[Fanconi anemia risk factors|Risk Factors]]==
Fanconi Anemia must be differentiated from Aplastic Anemia, Paraoxysomal Nocturnal Hemoglobinuria, and Chromosomal breakage syndrome and Hereditary Bone marrow failure syndrome (Dyskeratosis congenita and other short telomere syndromes).
* Fanconi Anemia must be differentiated from other diseases that cause Pancytopenia, Congenital anomalies, and associated with malignancy such as Aplastic Anemia, Rare chromosomal breakage syndrome and inherited bone marrow failure.<ref name="pmid24237973">{{cite journal| author=Hartung HD, Olson TS, Bessler M| title=Acquired aplastic anemia in children. | journal=Pediatr Clin North Am | year= 2013 | volume= 60 | issue= 6 | pages= 1311-36 | pmid=24237973 | doi=10.1016/j.pcl.2013.08.011 | pmc=3894991 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24237973  }}</ref>


* As Fanconi Anemia resembles with variety of other diseases that causes pancytopenia.
==[[Fanconi anemia screening|Screening]]==
* Must be differentiated on basis on congenital anomalies and chromosomal breakage test.<ref name="pmid27069254">{{cite journal| author=Arber DA, Orazi A, Hasserjian R, Thiele J, Borowitz MJ, Le Beau MM et al.| title=The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. | journal=Blood | year= 2016 | volume= 127 | issue= 20 | pages= 2391-405 | pmid=27069254 | doi=10.1182/blood-2016-03-643544 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27069254  }}</ref>
 
==[[Fanconi anemia epidemiology and demographics|Epidemiology and Demographics]]==
FA is rare overall, but it is one of the most common inherited bone marrow failure syndromes.
* The incidence of FA is approximately 1 in 100,000 to 250,000 births.
* Approximately 10 to 20 children are born with FA each year in the United States.<ref name="pmid21974856">{{cite journal| author=Rochowski A, Rosenberg PS, Alonzo TA, Gerbing RB, Lange BJ, Alter BP| title=Estimation of the prevalence of Fanconi anemia among patients with de novo acute myelogenous leukemia who have poor recovery from chemotherapy. | journal=Leuk Res | year= 2012 | volume= 36 | issue= 1 | pages= 29-31 | pmid=21974856 | doi=10.1016/j.leukres.2011.09.009 | pmc=4008327 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21974856  }}</ref>
* The probability of FA in the US population, FA, was estimated to be 1 in 129,600 births
* Most children are diagnosed between six and nine years of age, concurrent with the onset of bone marrow failure . Rarely, marrow failure from FA can present in infants and small children


==[[Fanconi anemia natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
==[[Fanconi anemia natural history, complications and prognosis|Natural History, Complications and Prognosis]]==


==Diagnosis==
== [[Fanconi anemia history and symptoms|History and Symptoms]] ==
[[Fanconi anemia history and symptoms|History and Symptoms]]
 
The majority of patients with fanconi anemia present with congenital anomalies. Sometimes, FA may be suspected at birth by one or more of these physical traits:
* Skin discolorations, Hand, arm and other skeletal anomalies, Kidney problems, Small head or eyes.
* Low birth weight, Gastrointestinal problems (bowel), Small reproductive organs in males, Heart defects.
Since these physical characteristics can be indicative of other conditions, and since some patients may have no obvious physical traits of FA, the condition may not be diagnosed at birth. They may exhibit symptoms such as:
* Unexplained fatigue, Recurrent colds or viral infections, Recurrent nosebleeds.
* Easy bruising, Blood in the stool or urine, Shortness of breath, Poor growth / short stature.
In rare cases, symptoms do not occur until early adulthood.
 
[[Fanconi anemia physical examination|Physical Examination]]
 
'''CLINICAL FEATURES:'''
 
The most common presenting features of FA are congenital malformations. Cytopenias are also common, and many patients eventually develop bone marrow failure. Common malignancies include myelodysplastic syndrome (MDS), leukemia, and solid tumors, especially squamous cell cancers (SCC)
 
== Physical Examination[edit | edit source] ==
* Congenital malformations are the most common presenting features of FA.


* Patients with FA usually present with hypo/hyperpigmentation, café-au-lait spots, short staure and thumb or other radial abnormalities.
== [[Fanconi anemia physical examination|Physical Examination]] ==


* Vital Signs Usually normal sometime patients present with fever due to superimposed infection.
== [[Fanconi anemia laboratory findings|Laboratory Findings]] ==


* Skin abnormalities in Fanconi anemia can include generalized hyperpigmentation on the trunk, neck, and intertriginous areas, the aforementioned café au lait spots, and hypopigmented areas. Delicate features can also be characteristic of patients.
== [[Fanconi anemia electrocardiogram|Electrocardiogram]] ==
[[Fanconi anemia laboratory findings|Laboratory Findings]]


The diagnosis of Fanconi anemia is not based on routine laboratory tests; it must be considered and tested for using chromosome breakage in blood or fibroblasts, or germline mutation analysis. Siblings who do not apparently have Fanconi anemia need to be screened for occult Fanconi anemia.
== [[Fanconi anemia x ray|X Ray]] ==


Any patient with single-lineage or multi-lineage cytopenias without known cause who also has one or more congenital malformations strongly associated with FA.
== [[Fanconi anemia medical therapy|Medical Therapy]] ==


Laboratory findings consistent with the diagnosis of Fanconi Anemia include Pancytopenia, Chromosomal breakage test positive, and Flow cytometry shows arrest in G2/M phase.
== [[Fanconi anemia surgery|Surgery]] ==


[[Fanconi anemia x ray|X Ray]]  
== [[Fanconi anemia primary prevention|Primary Prevention]] ==


Although non-specific, these are one of the best described features and include:
== [[Fanconi anemia secondary prevention|Secondary Prevention]] ==
* radial ray anomalies: including absent thumb.
* triphalangeal thumb.
Perform a skeletal survey to identify all developmental defects involving bone. Keep in mind that radiation doses should be limited in patients with Fanconi anemia. Care should be taken to avoid unnecessary radiation in patients with a cancer predisposition.


{{Family tree/start}}
== [[Fanconi anemia cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] ==
{{Family tree | | | | A01 | | | |A01=Suspected clinical FA}}
{{Family tree | | | | |!| | | | | }}
{{Family tree | | | | B01 | | | |B01=Chromosome breakage test on peripheral film}}
{{Family tree | |,|-|-|+|-|-|.| | }}
{{Family tree | |!| | D01 | |!| |D01=Ambiguous}}
{{Family tree | |!| | |!| | |!| | }}
{{Family tree | |!| | E01 | |!| |E01=Repeat Chromosome breakage test}}
{{Family tree | |)|-|-|^|-|-|(| | }}
{{Family tree | C01 | | | | C02 |C01=Abnormal| C02=Normal}}
{{Family tree | |!| | | | |,|^|-|-|.| }}
{{Family tree | |!| | | | |!| | | |!| }}
{{Family tree | |!| | | | F01 | | | F02 |F01=Highly suspected FA|F02=Not highly suspected FA}}
{{Family tree | |!| | | | |!| | | | |!| | }}
{{Family tree | |!| | | | |T01| | |!| |T01=Chromosome breakage test on skin fibroblast}}
{{Family tree | |!| | | |,|^|-|.| | |!| | }}
{{Family tree | |!| | | |!| | |!| | |!| | }}
{{Family tree | |!| | J01 | | | J02 |!|J01=Abnormal|J02=Normal}}
{{Family tree | |!| | | | | | | |!| |!| }}
{{Family tree | |!| | | | | | | | H01 |H01=Consider other IBMFS}}
{{Family tree | K01 | | | | | | | | | |K01=Diagnosis of FA}}
{{Family tree | |!| | | | | | | | | | | }}
{{Family tree | X01 | | | | | | | | | |X01=Genetic testing for Korean<br>mutations FANCA[[exon 27 & 37]]<br>FANCG[[intron 3 & exon 8]]}}
{{Family tree | |!| | | | | | | | | | | }}
{{Family tree | Z01 | | | | | | | | | |Z01=Other FA associated genes}}
{{Family tree/end}
==Treatment==
[[Fanconi anemia medical therapy|Medical Therapy]] | [[Fanconi anemia surgery|Surgery]] | [[Fanconi anemia cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Fanconi anemia future or investigational therapies|Future or Investigational Therapies]]


==Case Studies==
== [[Fanconi anemia future or investigational therapies|Future or Investigational Therapies]] ==
[[Fanconi anemia case study one|Case #1]]


==Related Chapters==
*[[Absent radius]]


==References==
==References==

Latest revision as of 16:39, 5 May 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shyam Patel [2]

Synonyms and keywords: Fanconi anaemia; Fanconi hypoplastic anemia; Fanconi panmyelopathy; Fanconi pancytopenia; FA

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Fanconi Anemia from Other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X Ray

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

References

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