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Galactosemia is an autosomal recessive disorder that results from a deficiency of any 1 of the 3 enzymes catalyzing the conversion of galactose to glucose: galactose-1-phosphate uridyltransferase (GALT), galactokinase (GALK), and uridine diphosphate galactose-4-epimerase (GALE). Galactose-1-phosphate (Gal-1-P) accumulates in the erythrocytes of patients with galactosemia due to either GALT or GALE deficiency. The quantitative measurement of Gal-1-P (GAL1P / Galactose-1-Phosphate (Gal-1-P), Erythrocytes) is useful for monitoring compliance with dietary therapy for either deficiency. Gal-1-P is thought to be the causative factor for development of liver disease in these patients and, because of this, patients should maintain low levels and be monitored on a regular basis. The concentration of Gal-1-P in erythrocytes is the most sensitive index of dietary control.
GALT deficiency is the most common cause of galactosemia and is often referred to as classic galactosemia. The complete or near-complete deficiency of GALT enzyme is life-threatening if left untreated. Complications in the neonatal period include failure to thrive, liver failure, sepsis, and death; even with survival, long-term intellectual disability can result.
Galactosemia due to GALT deficiency is treated by a galactose-restricted diet, which allows for rapid recovery from the acute symptoms and a generally good prognosis. Despite adequate treatment from an early age, individuals with galactosemia remain at increased risk for developmental delays, speech problems, and abnormalities of motor function. Females with galactosemia are at increased risk for premature ovarian failure. Based upon reports by newborn screening programs, the frequency of classic galactosemia in the United States is approximately 1 in 30,000, although literature reports range from 1 in 10,000 to 1 in 60,000 live births.
Epimerase deficiency galactosemia can be categorized into 3 types: generalized, peripheral, and intermediate. Generalized epimerase deficiency galactosemia results in profoundly decreased enzyme activity in all tissues, whereas peripheral epimerase deficiency galactosemia results in decreased enzyme activity in red and white blood cells, but normal enzyme activity in all other tissues. This is compared with intermediate epimerase deficiency galactosemia, which results in decreased enzyme activity in red and white blood cells and less than 50% of normal enzyme levels in other tissues.
Clinically, infants with generalized epimerase deficiency galactosemia develop symptoms such as liver and renal dysfunction and mild cataracts when on a normal milk diet, while infants with peripheral or intermediate epimerase deficiency galactosemia do not develop any symptoms. Generalized epimerase deficiency galactosemia is treated by a galactose- and lactose-restricted diet, which can improve or prevent the symptoms of renal and liver dysfunction and mild cataracts. Despite adequate treatment from an early age, individuals with generalized epimerase deficiency galactosemia remain at increased risk for developmental delay and intellectual disability. Unlike patients with classic galactosemia resulting from a GALT deficiency, females with generalized epimerase deficiency galactosemia experience normal puberty and are not at increased risk for premature ovarian failure. Based upon reports by newborn screening programs, the frequency of epimerase deficiency galactosemia in the United States ranges from approximately 1 in 6,700 in African American infants to 1 in 70,000 in infants of European ancestry.
For more information regarding diagnostic strategy, refer to Galactosemia: Current Testing Strategy and Aids for Test Selection, Mayo Medical Laboratories Communique 2005 May;30(5).
See Galactosemia Testing Algorithm in Special Instructions.
Monitoring dietary therapy of patients with galactosemia due to deficiency of galactose-1-phosphate uridyltransferase or uridine diphosphate galactose-4-epimerase
The concentration of galactose-1-phosphate (Gal-1-P) is provided along with reference ranges for patients with galactosemia and normal controls. The recommended Gal-1-P goal for patients with galactosemia is <125 mcg/g of hemoglobin.
See Galactosemia Testing Algorithm in Special Instructions for additional information.
Not a diagnostic test for galactosemia; to diagnose galactosemia, order GCT / Galactosemia Reflex, Blood.
Non-galactosemic: 5-49 mcg/g of hemoglobin (<1 mg/dL)
Galactosemic on galactose restricted diet: 80-125 mcg/g of hemoglobin (1-4 mg/dL)
Galactosemic on unrestricted diet: >125 mcg/g of hemoglobin (>4 mg/dL)
1. Berry GT: Classic Galactosemia and Clinical Variant Galactosemia. In GeneReviews. Edited by RA Pagon, MP Adam, HH Ardinger, et al. Available from URL http://www.ncbi.nlm.nih.gov/books/NBK1518/. Retrieved 03/11/2015
2. Walter JH, Fridovich-Keil JL: Chapter 72: Galactosemia. In The Metabolic and Molecular Bases of Inherited Disease. Eighth edition. Edited by D Valle. AL Beaudet, B Vogelstein. New York, McGraw-Hill Book Company. Accessed 03/11/2015. Available at: http:// www.ommbid.com