Hereditary spherocytosis

• Published in: The Lancet (British edition) Vol. 372; no. 9647; pp. 1411 - 1426
• Main Authors: Perrotta, Silverio, Gallagher, Patrick G, Mohandas, Narla
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 18.10.2008; Lancet; Elsevier Limited
• Subjects: Anemias. Hemoglobinopathies; Biological and medical sciences; Blood; Cells; Diseases of red blood cells; Erythrocytes; Gallbladder Diseases - etiology; General aspects; Genetic disorders; Hematologic and hematopoietic diseases; Hemolysis; Humans; Internal Medicine; Medical sciences; Membranes; Minority & ethnic groups; Mutation; Patients; Proteins; Risk assessment; Severity of Illness Index; Spherocytosis, Hereditary - genetics; Spherocytosis, Hereditary - physiopathology; Spherocytosis, Hereditary - therapy; Splenectomy; Medicine; Erythrocytic membrane disease; Hemolytic anemia; Hemopathy; Spherocytic anemia; Hereditary; Genetic disease
• ISSN: 0140-6736; 1474-547X; 1474-547X
• DOI: 10.1016/S0140-6736(08)61588-3

Hereditary spherocytosis is a common inherited disorder that is characterised by anaemia, jaundice, and splenomegaly. It is reported worldwide and is the most common inherited anaemia in individuals of northern European ancestry. Clinical severity is variable with most patients having a well-compensated haemolytic anaemia. Some individuals are asymptomatic, whereas others have severe haemolytic anaemia requiring erythrocyte transfusion. The primary lesion in hereditary spherocytosis is loss of membrane surface area, leading to reduced deformability due to defects in the membrane proteins ankyrin, band 3, β spectrin, α spectrin, or protein 4.2. Many isolated mutations have been identified in the genes encoding these membrane proteins; common hereditary spherocytosis-associated mutations have not been identified. Abnormal spherocytes are trapped and destroyed in the spleen and this is the main cause of haemolysis in this disorder. Common complications are cholelithiasis, haemolytic episodes, and aplastic crises. Splenectomy is curative but should be undertaken only after careful assessment of the risks and benefits.