{"id":2305,"date":"2017-10-12T15:47:23","date_gmt":"2017-10-12T15:47:23","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/hempor\/"},"modified":"2026-03-02T19:33:38","modified_gmt":"2026-03-02T19:33:38","slug":"hempor","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/hempor\/","title":{"rendered":"Diagnosis of Porphyria"},"content":{"rendered":"<div class=\"99c380e4b4a7b96c35d7ddf7dcb434e8\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p>The porphyrias are disorders of heme synthesis, which has eight steps.\u00a0Each type of porphyria involves a defect, either inherited or acquired, in a pathway\u00a0enzyme. When the defect is physiologically significant, it results in overproduction\u00a0of pathway precursors preceding the defective step which enter the circulation and\u00a0are excreted into urine or bile. The diseases have been grouped as acute hepatic\u00a0porphyrias and photocutaneous porphyrias. The acute porphyrias are due to hepatic\u00a0overproduction of the porphyrin precursors, delta aminolevulinic acid and\u00a0porphobilinogen, and the symptoms are caused by injury primarily to the nervous\u00a0system. Cutaneous porphyria is due to overproduction of photosensitizing porphyrins\u00a0by the liver or bone marrow, depending on the type of porphyria.<br \/>\n<!--more--><br \/>\n<strong>Principal Types of Porphyria<\/strong><\/p>\n<table style=\"border-collapse: collapse; width: 100%;\" border=\"1\">\n<tbody>\n<tr>\n<td><strong>Feature<\/strong><\/td>\n<td><strong>Acute Intermittent Porphyria<\/strong><\/td>\n<td><strong>Porphyria Cutanea Tarda<\/strong><\/td>\n<td><strong>Protoporphyria<\/strong><\/td>\n<\/tr>\n<tr>\n<td>Tissue site<\/td>\n<td>Liver<\/td>\n<td>Liver<\/td>\n<td>Bone marrow<\/td>\n<\/tr>\n<tr>\n<td>Manifestations<\/td>\n<td>Pain in the abdomen and back and nausea, both of which increase over a few days; tachycardia without fever; seizures (in 20% of patients)<\/td>\n<td>Slow onset of painless blisters, fragile skin, scars, hypertrichosis on sun-exposed skin<\/td>\n<td>Rapid onset of pain, edema, and itching after sun exposure; thickening of perioral skin and skin over the knuckles with repeated exposure<\/td>\n<\/tr>\n<tr>\n<td>Age at onset and sex<\/td>\n<td>18\u201345 yr; 90% female predominance<\/td>\n<td>&gt;40 yr; male predominance<\/td>\n<td>1\u20133 yr (although delayed diagnosis is common); equal male\u2013female incidence<\/td>\n<\/tr>\n<tr>\n<td>Color of urine<\/td>\n<td>Normal to dark amber<\/td>\n<td>Brown or reddish brown<\/td>\n<td>Normal<\/td>\n<\/tr>\n<tr>\n<td>Associated conditions, environmental factors<\/td>\n<td>Use of cytochrome P-450\u2013inducing medications or oral contraceptive pills, severely restricted caloric intake<\/td>\n<td>Hepatitis C virus infection, human immunodeficiency virus infection, iron overload, use of alcohol, use of estrogen<\/td>\n<td>History of gallstones, microcytic anemia, cholestasis<\/td>\n<\/tr>\n<tr>\n<td>Skin lesions<\/td>\n<td>None<\/td>\n<td>Painless blisters on sun-exposed skin, shallow open sores, depigmented scars<\/td>\n<td>Acute injury: erythema and mild edema; chronic injury: lichenified skin over knuckles and around mouth<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong>Heme Pathway Intermediates in the Diagnosis of Porphyria<\/strong><\/p>\n<table style=\"border-collapse: collapse; width: 100%;\" border=\"1\">\n<tbody>\n<tr>\n<td><strong>Pathway Intermediate<\/strong><\/td>\n<td style=\"text-align: center;\"><strong>Porphobilinogen in urine (mg\/g of creatinine)<\/strong><\/td>\n<td style=\"text-align: center;\"><strong>Uroporphyrin in urine (ug\/g of creatinine)<\/strong><\/td>\n<td style=\"text-align: center;\"><strong>Protoporphyrin in blood (ug\/dl)<\/strong><\/td>\n<\/tr>\n<tr>\n<td>Reference Range<\/td>\n<td style=\"text-align: center;\">0-2<\/td>\n<td style=\"text-align: center;\">0-30<\/td>\n<td style=\"text-align: center;\">0-80<\/td>\n<\/tr>\n<tr>\n<td>Asymptomatic Acute Intermittent Porphyria<\/td>\n<td style=\"text-align: center;\">1-10**<\/td>\n<td style=\"text-align: center;\">&lt;3<\/td>\n<td style=\"text-align: center;\">&#8211;<\/td>\n<\/tr>\n<tr>\n<td>Acute Intermittent Porphyria during Attack<\/td>\n<td style=\"text-align: center;\">20-300<\/td>\n<td style=\"text-align: center;\">20-200<\/td>\n<td style=\"text-align: center;\">&#8211;<\/td>\n<\/tr>\n<tr>\n<td>Porphyria Cutanea Tarda without Symptoms (Treated)<\/td>\n<td style=\"text-align: center;\">&lt;2<\/td>\n<td style=\"text-align: center;\">30-300<\/td>\n<td style=\"text-align: center;\">&#8211;<\/td>\n<\/tr>\n<tr>\n<td>Active (Untreated) Porphyria Cutanea Tarda<\/td>\n<td style=\"text-align: center;\">&lt;4<\/td>\n<td style=\"text-align: center;\">&gt;500<\/td>\n<td style=\"text-align: center;\">&#8211;<\/td>\n<\/tr>\n<tr>\n<td>Protoporphyri<strong>a<\/strong><\/td>\n<td style=\"text-align: center;\">&#8211;<\/td>\n<td style=\"text-align: center;\">&#8211;<\/td>\n<td style=\"text-align: center;\">&gt;400<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>To convert the values for porphobilinogen to micromoles per day, divide by 0.226. To convert the values for uroporphyrin to nanomoles per\u00a0day, divide by 0.831. To convert the values for blood protoporphyrin to nanomoles per deciliter, divide by 0.563.<br \/>\n** In a minority of asymptomatic carriers, the level of urine porphobilinogen is higher than 10 mg per gram of creatinine. The risk of an attack\u00a0is increased, relative to the risk when the baseline porphobilinogen level is normal or only slightly elevated.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>References:<\/strong><\/p>\n<ol>\n<li>Bissell DM, Anderson KE, Bonkovsky HL. Porphyria. N Engl J Med. 2017 Aug 31;377(9):862-872. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/28854095\/\" target=\"_blank\" rel=\"noopener\">[Medline]<\/a><\/li>\n<li>Karim Z, Lyoumi S, Nicolas G, Deybach JC, Gouya L, Puy H. Porphyrias: A 2015 update. Clin Res Hepatol Gastroenterol. 2015 Sep;39(4):412-25. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/26142871\/\" target=\"_blank\" rel=\"noopener\">[Medline]<\/a><\/li>\n<li>Leaf RK, Dickey AK. Porphyria cutanea tarda: a unique iron-related disorder. Hematology Am Soc Hematol Educ Program. 2024 Dec 6;2024(1):450-456. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/39644053\/\" target=\"_blank\" rel=\"noopener\">[Medline]<\/a><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p>Created Oct 13, 2017.<br \/>\nUp-date Mar 2, 2026.<\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>Sorry, this entry is only available in Espa\u00f1ol.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"no","_lmt_disable":"no","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[171],"tags":[582,123,13,581,580,579,578,577,576,575,574,573,572,583],"class_list":["post-2305","post","type-post","status-publish","format-standard","hentry","category-hematology","tag-cutanea","tag-diagnosis","tag-diagnostico","tag-porfiria","tag-porfobilinogeno","tag-porphobilinogen","tag-porphyria","tag-protoporfiria","tag-protoporfirina","tag-protoporphyria","tag-protoporphyrin","tag-tarda","tag-uroporfirina","tag-uroporphyrin"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2305","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/comments?post=2305"}],"version-history":[{"count":4,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2305\/revisions"}],"predecessor-version":[{"id":10687,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2305\/revisions\/10687"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/media?parent=2305"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/categories?post=2305"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/tags?post=2305"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}