Case Report

Erythrocytosis due to PHD2 Mutations: A Review of Clinical Presentation, Diagnosis, and Genetics

Table 1

Characteristics of patients with PHD2 mutations and polycythemia.

NumberAge/sexHb (g/L)EPO (IU/L)Relevant clinical dataMode of inheritanceAssociated mutationsRelation to protein structure Protein changes and mutation
(catalytic domain from amino acid residues 181–426 [15])
Reference

143 (44) M20224.0 (5–25)N/AN/AHomozygous JAK2 V617FSubstitution between N-terminal MYND zinc finger-like domain and conserved C-terminal catalytic domainp.(Gln157His);
c.471G>C
Ladroue et al. [6]

265 (65) M17129.0 (5–30)Thrombocytosis, leukocytosis and splenomegaly,
Phlebotomies, and hydroxycarbamide
Autosomal dominantHomozygous JAK2 V617FSubstitution between N-terminal MYND zinc finger-like domain and conserved C-terminal catalytic domainp.(Gln157His);
c.471G>C
Albiero et al. [16]

340 (40) M1708.0 (5–30)N/AAutosomal dominantNoneSubstitution between N-terminal MYND zinc finger-like domain and conserved C-terminal catalytic domainp.(Gln157His);
c.471G>C
Albiero et al. [16]

422 (34) M17990.0 (5–25)N/AN/ANoneSubstitution of highly conserved amino acid one residue from site that chelates Zn and Cd ions Mutation causes delayed hydroxylation of HIF-αp.(Pro200Gln);
c.599C>A
Ladroue et al. [6]

554 (54) M19220.0 (5–25)Inflammatory arthromyalgia, visual symptoms, and phlebotomiesAutosomal dominantNoneTruncation in catalytic domain of 154 C-terminal amino acidsp.(Met202Ilefs72); c.606delG Al-Sheikh et al. [17]

6>54 (>54) M17111.5 (5–25)PhlebotomiesAutosomal dominantNoneTruncation in catalytic domain of 154 C-terminal amino acidsp.(Met202Ilefs72); c.606delGAl-Sheikh et al. [17]

761 (80) M2302.0 (5–25)Hemorrhage, phlebotomy, and aspirinN/AJAK2-exon 12Substitution of highly conserved part of catalytic sitep.(Asn203Lys);
c.609C>G
Albiero et al. [18]

849 (46) M20011.0 (5–25)Cardiac diseaseN/ANoneSubstitution mutation of catalytic sitep.(Lys204Glu);
c.610G>A
Bento et al. [19]

952 (51) M1838.13 (5–25)Klinefelter’s syndromeN/ANoneTruncation mutation of catalytic sitep.(Gln221);
c.661C>T
Lambert, unpublished data (2013)

1034 (24) M172N/AHeadachesN/ANoneTruncation mutation of catalytic sitep.(Arg227Alafs20); c.678dupGBento and Almeida, unpublished data (2014)

1116 (60) F16040.5 (<31.5)Red eyes, flushed cheeks and feet headache, episodic chest pain palpitations, and primary hyperparathyroidism
cystic kidney disease paraganglioma pheochromocytoma repeated phlebotomies
N/ANoneSubstitution of highly conserved residue site likely to affect protein folding and stabilityp.(Ala228Ser);
c.682G>T
Yang et al. [8]

1252 (58) M 178N/AN/ANoneTruncation mutation of catalytic sitep.(Gln239);
c.715C>T
Bento and Almeida, unpublished data (2014)

1325 (48) M1922x normal (5–25)N/AN/ANoneSubstitution of highly conserved residue of catalytic sitep.(Asp254His);
c.760G>C
Ladroue et al. [6]

1473 (73) M1881.3 (10.2–28.5)SmokerN/ANoneLoss of catalytic activity of PHD2 proteinp.(Leu279Thrfs43);
c.835del14
Jang et al. [20]

1522 (22) M178N/ATinnitusN/ANoneTruncation of 143 C-terminal amino acidsp.(Arg281Thrfs3);
c.840_841insA
Al-Sheikh et al. [17]

1668 (65) M18360 (5–25)N/ANoneSubstitution mutation of catalytic sitep.(Gly285Arg);
c.853G>C
Bento et al. [19]

1729 (38) M1765.0 (5–25)N/AAutosomal dominantNoneSubstitution of nonconserved residue of catalytic domainp.(Lys291Ile);
c.872A>T
Albiero et al. [18]

1848 (48) F1806.2 (5–25)Leukoclastic vasculitisN/ANoneSubstitution mutation of catalytic sitep.(Pro304Leu);
c.911C>T
Percy and McMullin, unpublished data (2004)

1945 (45) M180N/ASmoker with intermittent claudication and death from esophageal carcinomaAutosomal dominantNoneSubstitution of highly conserved amino acid, close proximity to site responsible for coordinating Fe2+ at active sitep.(Pro317Arg);
c.950C>G
Percy et al. [2]

2026 (26) F1806.3 (5–25)Superficial thrombophlebitis, history of menorrhagia, and phlebotomiesAutosomal dominantNoneSubstitution of highly conserved amino acid, close proximity to site responsible for coordinating Fe2+ at active sitep.(Pro317Arg);
c.950C>G
Percy et al. [2]

2130 (30) M1756.4 (5–25)Paresthesia, absent left kidney, and enlarged right kidneyAutosomal dominantNoneSubstitution of highly conserved amino acid, close proximity to site responsible for coordinating Fe2+ at active sitep.(Pro317Arg);
c.950C>G
Percy et al. [2]

2231 (31) F1746.0 (3–34)N/AAutosomal dominantNoneSubstitution of highly conserved amino acid of catalytic domainp.(Trp334Arg);
c.1000T>C
Bento et al. [21]

2349 (55) M2158.3 (4–16)PhlebotomiesSister has polycythemiaNoneTruncation in highly conserved amino acid residue in catalytic domainp.(Trp334);
c.1001G>A
(this paper)

2435 (35) F17810.7 (5–25)PhlebotomiesN/ANoneTruncation of 50 C-terminal amino acidsp.(Gln337);
c.1129C>T
Al-Sheikh et al. [17]

2521 (24) M1719.9 (5–25)TIAN/ANoneTruncation mutation of catalytic sitep.(Val338Glyfs18);
c.1010dup
Bento et al. [19]

2647 (47) M1689.5 (5–25)N/ANoneSubstitution mutation of catalytic sitep.(Arg371Cys);
c.1111C>T
Percy and McMullin, unpublished data (2013)

2717 (25) M191Normal (5–25)N/AN/ANoneSubstitution of highly conserved amino acid 3 residues away from Fe2+ chelating residuep.(Arg371His);
c.1112G>A
Ladroue et al. [6]

2829 (38) M18812.0 (5–25)Sagittal sinus thrombosis and phlebotomiesN/ANoneSubstitution of highly conserved amino acid 3 residues away from Fe2+ chelating residuep.(Arg371His);
c.1112G>A
Percy et al. [3]

2930 (43) M20218.0 (5–25)Recurrent para-aortic paraganglioma hypertension phlebotomiesN/AHomozygous C282Y mutationSubstitution of highly conserved amino acid critical to coordinating Fe2+ bindingp.(His374Arg);
c.1121A>G
Ladroue et al. [12]

3064 (67) F161N/ASuspected liver and renal angiomasAutosomal dominantNoneTruncation in catalytic domainp.(Arg398);
c.1192C>T
Ladroue et al. [6]

3126 (41) M1936.5 (5–25)N/AAutosomal dominantNoneTruncation in catalytic domainp.(Arg398);
c.1192C>T
Ladroue et al. [6]

3260 (80) M16423.0 (5–25)Treated with aspirin and phlebotomiesN/ANoneSubstitution of highly conserved residue mutation of catalytic domain p.(Lys423Glu);
c.1267A>G
Albiero et al. [18]

Age at diagnosis (age at workup for mutation).
Original sources listed, data later compiled in review by Gardie et al. [22]
Mode of inheritance determined by family history.