Hereditary spherocytosis natural history, complications and prognosis: Difference between revisions

Jump to navigation Jump to search
No edit summary
 
(25 intermediate revisions by 2 users not shown)
Line 5: Line 5:


==Overview==
==Overview==
[[Hereditary spherocytosis]] can present at any [[Ageing|age]] with any severity, ranging from [[hydrops fetalis]] [[Uterus|in utero]] through [[diagnosis]] in the ninth decade of [[life]], with variable [[clinical]] [[Course (medicine)|course]] depending upon the severity of [[disease]]. Majority of affected individuals have mild or moderate [[hemolysis]] and known [[family history]], making the [[diagnosis]] and treatment relatively easy. [[Complication (medicine)|Complications]] include; [[jaundice]], [[kernicterus]], [[Gallstones|pigment gallstones]], [[Hemolysis|hemolytic]], [[Aplastic anemia|aplastic]] and [[Megaloblastic anemia|megaloblastic crises]], [[splenomegaly]] and [[leukemia]]. The [[prognosis]] is usually good with early [[diagnosis]], regular followup and management. [[Patient|Patients]] with mild [[disease]] may develop [[Symptom|symptoms]] only with environmental [[Trigger|triggers]]. Many [[Patient|patients]] who undergo [[splenectomy]] are able to maintain normal [[Hemoglobin|hemoglobin levels]], however [[Patient|patients]] with severe [[hereditary spherocytosis]] may remain [[Anemia|anemic]] [[Splenectomy|postsplenectomy]] and require regular [[Blood transfusion|blood transfusions]]. [[Splenectomy|Postsplenectomy]] [[Patient|patients]] are at increased risk of [[life]] threatening [[Infection|infections]] ([[sepsis]]), therefore require [[Vaccination|vaccinations]] and [[Antibiotic|antibiotics]].
==Natural History==
==Natural History==
* '''Disease severity and age of presentation''' — HS can present at any age and with any severity, with case reports describing a range of presentations, from hydrops fetalis in utero through diagnosis in the ninth decade of life. <ref name="pmid18940465">{{cite journal| author=Perrotta S, Gallagher PG, Mohandas N| title=Hereditary spherocytosis. | journal=Lancet | year= 2008 | volume= 372 | issue= 9647 | pages= 1411-26 | pmid=18940465 | doi=10.1016/S0140-6736(08)61588-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18940465  }}</ref><ref name="pmid1954389">{{cite journal| author=Whitfield CF, Follweiler JB, Lopresti-Morrow L, Miller BA| title=Deficiency of alpha-spectrin synthesis in burst-forming units-erythroid in lethal hereditary spherocytosis. | journal=Blood | year= 1991 | volume= 78 | issue= 11 | pages= 3043-51 | pmid=1954389 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1954389  }}</ref><ref name="pmid2391596">{{cite journal| author=Eber SW, Armbrust R, Schröter W| title=Variable clinical severity of hereditary spherocytosis: relation to erythrocytic spectrin concentration, osmotic fragility, and autohemolysis. | journal=J Pediatr | year= 1990 | volume= 117 | issue= 3 | pages= 409-16 | pmid=2391596 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2391596  }}</ref>
* The [[clinical]] [[Course (medicine)|course]] of [[hereditary spherocytosis]] is [[variable]] depending upon the severity of [[disease]].<ref>{{Cite journal
| author = [[Olga Ciepiela]]
| title = Old and new insights into the diagnosis of hereditary spherocytosis
| journal = [[Annals of translational medicine]]
| volume = 6
| issue = 17
| pages = 339
| year = 2018
| month = September
| doi = 10.21037/atm.2018.07.35
| pmid = 30306078
}}</ref>
* During [[Infant|infancy]], [[Hemoglobin|hemoglobin level]] falls rapidly after 20 days of [[birth]] leading to [[Transient state (chemical engineering)|transient]] & severe [[anemia]], causing inappropriate [[Red blood cell|erythrocyte]] response and [[Spleen|splenic]] filtering [[Function (biology)|function]].<ref>{{Cite journal
| author = [[F. Delhommeau]], [[T. Cynober]], [[P. O. Schischmanoff]], [[P. Rohrlich]], [[J. Delaunay]], [[N. Mohandas]] & [[G. Tchernia]]
| title = Natural history of hereditary spherocytosis during the first year of life
| journal = [[Blood]]
| volume = 95
| issue = 2
| pages = 393–397
| year = 2000
| month = January
| pmid = 10627440
}}</ref>
* About 20-30% of [[Patient|patients]] have [[Disease|mild disease]] with compensated [[hemolysis]].
* About 60-70% of [[Patient|patients]] have [[Disease|moderate disease]], presenting in [[Child|childhood]] but can present at any [[Ageing|age]].
* About 3-5% of [[Patient|patients]] have severe [[Heredity|hereditary]] [[disease]] with [[life]] threatening [[anemia]], requiring regular [[Blood transfusion|transfusions]] to maintain a [[Hemoglobin|hemoglobin concentration]] of greater than 60g/L.
* Without regular [[Blood transfusion|transfusions]] or [[splenectomy]] or both, [[Patient|patients]] may develop [[kernicterus]], [[Hemolytic anemia|severe hemolytic anemia]], [[Gallstone disease|gallstones]], [[growth retardation]], delayed [[sexual]] [[maturation]], [[extramedullary hematopoiesis]] with [[hepatosplenomegaly]] and [[Bone|bony]] changes ([[Thalassemia|thalassemic facies]]).<ref name="PerrottaGallagher2008">{{cite journal|last1=Perrotta|first1=Silverio|last2=Gallagher|first2=Patrick G|last3=Mohandas|first3=Narla|title=Hereditary spherocytosis|journal=The Lancet|volume=372|issue=9647|year=2008|pages=1411–1426|issn=01406736|doi=10.1016/S0140-6736(08)61588-3}}</ref>


* The majority of affected individuals have mild or moderate hemolysis or hemolytic anemia and a known family history, making diagnosis and treatment relatively straightforward [63]. Individuals with significant severe hemolysis may develop additional complications such as jaundice/hyperbilirubinemia, folate deficiency, or splenomegaly.
* [[Hereditary spherocytosis]] can present at any [[Ageing|age]] and with any severity, with [[Case report|case reports]] describing a range of presentations, from [[hydrops fetalis]] [[Uterus|in utero]] through [[diagnosis]] in the ninth decade of [[life]]. <ref name="pmid18940465">{{cite journal| author=Perrotta S, Gallagher PG, Mohandas N| title=Hereditary spherocytosis. | journal=Lancet | year= 2008 | volume= 372 | issue= 9647 | pages= 1411-26 | pmid=18940465 | doi=10.1016/S0140-6736(08)61588-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18940465 }}</ref><ref name="pmid1954389">{{cite journal| author=Whitfield CF, Follweiler JB, Lopresti-Morrow L, Miller BA| title=Deficiency of alpha-spectrin synthesis in burst-forming units-erythroid in lethal hereditary spherocytosis. | journal=Blood | year= 1991 | volume= 78 | issue= 11 | pages= 3043-51 | pmid=1954389 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1954389  }}</ref><ref name="pmid2391596">{{cite journal| author=Eber SW, Armbrust R, Schröter W| title=Variable clinical severity of hereditary spherocytosis: relation to erythrocytic spectrin concentration, osmotic fragility, and autohemolysis. | journal=J Pediatr | year= 1990 | volume= 117 | issue= 3 | pages= 409-16 | pmid=2391596 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2391596 }}</ref>
'''Hemolytic anemia''' — A classification for HS has been developed based on the severity of anemia and markers of hemolysis (reticulocyte count and bilirubin) <ref name="pmid15287938">{{cite journal| author=Bolton-Maggs PH, Stevens RF, Dodd NJ, Lamont G, Tittensor P, King MJ et al.| title=Guidelines for the diagnosis and management of hereditary spherocytosis. | journal=Br J Haematol | year= 2004 | volume= 126 | issue= 4 | pages= 455-74 | pmid=15287938 | doi=10.1111/j.1365-2141.2004.05052.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15287938 }}</ref><ref name="pmid152879382">{{cite journal| author=Bolton-Maggs PH, Stevens RF, Dodd NJ, Lamont G, Tittensor P, King MJ et al.| title=Guidelines for the diagnosis and management of hereditary spherocytosis. | journal=Br J Haematol | year= 2004 | volume= 126 | issue= 4 | pages= 455-74 | pmid=15287938 | doi=10.1111/j.1365-2141.2004.05052.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15287938 }}</ref>; it characterizes patients as having one of the following:


●HS trait – Normal hemoglobin and reticulocyte count
* The majority of affected individuals have mild or moderate hemolysis or [[hemolytic anemia]] and a known family history, making diagnosis and treatment relatively straightforward. Individuals with significant severe hemolysis may develop additional complications such as [[jaundice]]/[[hyperbilirubinemia]], [[folate deficiency]], or [[splenomegaly]].
'''[[Hemolytic anemia]]''' — A [[classification]] for [[Hereditary spherocytosis|hereditary spherocytosis]] has been developed based on the severity of [[anemia]] and markers of [[hemolysis]] ([[reticulocyte count]] and [[bilirubin]]) <ref name="pmid15287938">{{cite journal| author=Bolton-Maggs PH, Stevens RF, Dodd NJ, Lamont G, Tittensor P, King MJ et al.| title=Guidelines for the diagnosis and management of hereditary spherocytosis. | journal=Br J Haematol | year= 2004 | volume= 126 | issue= 4 | pages= 455-74 | pmid=15287938 | doi=10.1111/j.1365-2141.2004.05052.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15287938  }}</ref><ref name="pmid152879382">{{cite journal| author=Bolton-Maggs PH, Stevens RF, Dodd NJ, Lamont G, Tittensor P, King MJ et al.| title=Guidelines for the diagnosis and management of hereditary spherocytosis. | journal=Br J Haematol | year= 2004 | volume= 126 | issue= 4 | pages= 455-74 | pmid=15287938 | doi=10.1111/j.1365-2141.2004.05052.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15287938  }}</ref>; it characterizes [[Patient|patients]] as having one of the following:


●Mild HS (20 to 30 percent of cases) Hemoglobin 11 to 15 g/dL; reticulocytes 3 to 6 percent; bilirubin 17 to 34 micromol/L
●[[Hereditary spherocytosis]] [[trait]] Normal [[hemoglobin]] and [[reticulocyte count]]


●Moderate HS (60 to 75 percent of cases) – Hemoglobin 8 to 12 g/dL; reticulocytes >6 percent; bilirubin >34 micromol/L
●Mild [[Hereditary Spherocytosis|hereditary spherocytosis]] (20 to 30 percent of cases) – [[Hemoglobin]] 11 to 15 g/dL; [[reticulocytes]] 3 to 6 percent; [[bilirubin]] 17 to 34 micromol/L


●Severe HS (5 percent of cases) – Hemoglobin 6 to 8 g/dL; reticulocytes >10 percent; bilirubin >51 micromol/L
●Moderate [[Hereditary spherocytosis|hereditary spherocytosis]] (60 to 75 percent of cases) – [[Hemoglobin]] 8 to 12 g/dL; [[reticulocytes]] >6 percent; [[bilirubin]] >34 micromol/L
* Neonates may have a relatively normal hemoglobin level at birth that is followed by development of severe anemia, especially during the first three weeks and, in some cases, the first year of life, when the erythropoietic response may not be adequate [81,82]. According to one review, more than half of neonates with HS are not anemic during the first week of life [83]. However, anemia can develop after several days, and is most likely to be severe during the second or third week of life. Some infants require chronic transfusions during the first year; however, transfusion dependence beyond the first year of life is unusual. 


* In older children and adults, the presentation may be that of an incidental finding of hemolysis, hemolytic anemia, or spherocytes on the blood smear (picture 2), or the individual may be symptomatic from anemia, splenomegaly, pigment gallstones, or jaundice. Jaundice due to severe hemolysis is less common after the newborn period.  
●Severe [[Hereditary spherocytosis|hereditary spherocytosis]] (5 percent of cases) – [[Hemoglobin]] 6 to 8 g/dL; [[reticulocytes]] >10 percent; [[bilirubin]] >51 micromol/L
* [[Neonates]] may have a relatively normal [[hemoglobin]] level at [[birth]] that is followed by [[development]] of severe [[anemia]], especially during the first three weeks and, in some cases, the first year of [[life]], when the [[Erythropoiesis|erythropoietic]] response may not be adequate.
* According to one review, more than half of [[Infant|neonates]] with [[Hereditary spherocytosis|hereditary spherocytosis]] are not [[anemic]] during the first week of [[life]] <ref name="pmid26009624">{{cite journal| author=Christensen RD, Yaish HM, Gallagher PG| title=A pediatrician's practical guide to diagnosing and treating hereditary spherocytosis in neonates. | journal=Pediatrics | year= 2015 | volume= 135 | issue= 6 | pages= 1107-14 | pmid=26009624 | doi=10.1542/peds.2014-3516 | pmc=4444801 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26009624  }}</ref>.
* However, [[anemia]] can develop after several days, and is most likely to be severe during the second or third week of [[life]]. Some [[infants]] require [[Chronic (medical)|chronic]] [[transfusions]] during the first year; however, [[transfusion]] dependence beyond the first year of [[life]] is unusual.


* In some cases, co-inheritance of another disorder affecting RBC survival such as sickle cell disease or thalassemia can influence the severity of anemia and make diagnosis more challenging [80].  
* In older [[Child|children]] and [[Adult|adults]], the presentation may be that of an incidental finding of [[hemolysis]], [[hemolytic anemia]], or [[Spherocyte|spherocytes]] on the [[Blood film|blood smear]] or the individual may be [[symptomatic]] from [[anemia]], [[splenomegaly]], [[Gallstones|pigment gallstones]], or [[jaundice]]. [[Jaundice]] due to severe [[hemolysis]] is less common after the [[newborn]] period.
 
* In some cases, [[Inheritance|co-inheritance]] of another [[Disorder (medicine)|disorder]] affecting [[Red blood cell|RBC]] [[Survival analysis|survival]] such as [[sickle cell]] [[disease]] or [[thalassemia]] can influence the severity of [[anemia]] and make [[diagnosis]] more challenging. <ref name="pmid22055020">{{cite journal| author=Bolton-Maggs PH, Langer JC, Iolascon A, Tittensor P, King MJ, General Haematology Task Force of the British Committee for Standards in Haematology| title=Guidelines for the diagnosis and management of hereditary spherocytosis--2011 update. | journal=Br J Haematol | year= 2012 | volume= 156 | issue= 1 | pages= 37-49 | pmid=22055020 | doi=10.1111/j.1365-2141.2011.08921.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22055020  }}</ref>


==Complications==
==Complications==
'''Exacerbations of anemia''' '''in certain settings:'''
* The [[Complication (medicine)|complications]] of [[hereditary spherocytosis]] include:<ref>{{Cite journal
 
| author = [[Sayeeda Huq]], [[Mark A. C. Pietroni]], [[Hafizur Rahman]] & [[Mohammad Tariqul Alam]]
●Infections that impair RBC production in the bone marrow and thus diminish the capacity to compensate for chronic hemolysis may lead to a period of aplasia. A commonly cited cause of transient aplastic crisis is parvovirus B19 infection; other viral or bacterial infections may also cause transient aplasia. This is because individuals with chronic hemolysis are highly dependent on the accelerated production of new RBCs by the bone marrow, and they can experience a rapid drop in hemoglobin level when the bone marrow is unable to compensate for hemolysis. If an individual with HS develops a precipitous decline in hemoglobin level or reticulocyte count, testing for parvovirus infection is appropriate.  
| title = Hereditary spherocytosis
 
| journal = [[Journal of health, population, and nutrition]]
●Conditions that increase the size of the spleen, such as infectious mononucleosis, may cause increased splenic pooling of RBCs and/or increased hemolysis.  
| volume = 28
 
| issue = 1
●Individuals who develop folate, vitamin B12, or iron deficiency may be unable to produce sufficient RBCs to compensate for those lost by hemolysis.  
| pages = 107–109
 
| year = 2010
●Anemia may worsen during pregnancy, as the RBC mass and plasma volume expand to meet the physiologic needs of the pregnancy. Attention to folic acid supplantation and iron stores are also important so as not to impair RBC production.
| month = February
 
| pmid = 20214092
●Individuals who experience a decline from their baseline hemoglobin level and/or reduction in baseline reticulocyte count are likely to require more frequent monitoring and/or additional testing, details of which will depend on the associated symptoms and laboratory findings.
}}</ref><ref name="FriedmanWilliams1988">{{cite journal|last1=Friedman|first1=Ellen Wolkin|last2=Williams|first2=Jeannine C.|last3=van Hook|first3=Lucille|title=Hereditary spherocytosis in the elderly|journal=The American Journal of Medicine|volume=84|issue=3|year=1988|pages=513–516|issn=00029343|doi=10.1016/0002-9343(88)90275-6}}</ref><ref name="GuittonGarçon2008">{{cite journal|last1=Guitton|first1=C.|last2=Garçon|first2=L.|last3=Cynober|first3=T.|last4=Gauthier|first4=F.|last5=Tchernia|first5=G.|last6=Delaunay|first6=J.|last7=Leblanc|first7=T.|last8=Thuret|first8=I.|last9=Bader-Meunier|first9=B.|title=Sphérocytose héréditaire : recommandations pour le diagnostic et la prise en charge chez l’enfant|journal=Archives de Pédiatrie|volume=15|issue=9|year=2008|pages=1464–1473|issn=0929693X|doi=10.1016/j.arcped.2008.04.023}}</ref>
 
** [[hemolytic anemia]]
'''Complications of hemolysis''' — Common complications of hemolysis include neonatal jaundice, splenomegaly, and pigment gallstones.
** [[jaundice]]
 
** [[kernicterus]]
●Rarely, hemolysis may be severe enough to cause extramedullary hematopoiesis and/or growth delay [84,85]. A small subset of these children may be at risk for iron overload due to increased iron absorption and/or transfusions, although the majority of patients with HS do not develop iron overload [62].
** [[cholelithiasis]]
 
** [[Hemolysis|hemolytic]], [[Aplastic anemia|aplastic]] and [[Megaloblastic anemia|megaloblastic]] crises
●Other rare complications that have been reported include leg ulcers, priapism, neuromuscular disorders, cardiac disease, and gout; in some cases, these may represent coincidental rather than causal associations [62,86,87].
** [[growth failure]]
** [[Leg ulcer|leg ulcers]]
** [[Skeleton|skeletal]] abnormalities resulting from [[bone marrow]] expansion
** [[multiple myeloma]]
** [[leukemia]]
* [[Infection|Infections]] that impair [[RBC]] production in the [[bone marrow]] and thus diminish the capacity to compensate for [[Chronic (medical)|chronic]] [[hemolysis]] may lead to a period of [[aplasia]]. A commonly cited [[Causality|cause]] of [[transient]] [[aplastic crisis]] is [[parvovirus B19]] [[infection]]; other [[Virus|viral]] or [[Bacteria|bacterial]] [[Infection|infections]] may also cause [[transient]] [[aplasia]]. This is because individuals with [[Chronic (medical)|chronic]] [[hemolysis]] are highly dependent on the accelerated production of new [[Red blood cell|RBCs]] by the [[bone marrow]], and they can experience a rapid drop in [[hemoglobin]] level when the [[bone marrow]] is unable to compensate for [[hemolysis]]. If a [[patient]] with [[Hereditary spherocytosis|hereditary spherocytosis]] develops a precipitous decline in [[hemoglobin]] level or [[reticulocyte count]], [[Test|testing]] for [[Parvovirus B19 infection|parvovirus infection]] is appropriate.  
* [[Disease|Conditions]] that increase the size of the [[spleen]], such as [[infectious mononucleosis]], may cause increased [[Spleen|splenic]] pooling of [[Red blood cell|RBCs]] and/or increased [[hemolysis]].  
* Individuals who develop [[folate]], [[vitamin B12]], or [[iron deficiency]] may be unable to produce sufficient [[Red blood cell|RBCs]] to compensate for those lost by [[hemolysis]].  
* [[Anemia]] may worsen during [[pregnancy]], as the [[RBC]] mass and [[Plasma|plasma volume]] expand to meet the [[Physiology|physiologic]] needs of the [[pregnancy]]. Attention to [[Folic Acid|folic acid]] supplementation and [[iron]] stores are also important so as not to impair [[Red blood cell|RBC]] production.  


'''Neonatal jaundice''' — HS may present in the neonatal period with jaundice and hyperbilirubinemia, and the serum bilirubin level may not peak until several days after birth. Some experts have proposed that HS is underdiagnosed as a cause of neonatal jaundice [88]. A requirement for phototherapy and/or exchange transfusion during this period is common [62,81]. (See 'Neonates' below.)
'''Complications of [[hemolysis]]''' — [[Common-cause and special-cause|Common]] [[Complication (medicine)|complications]] of [[hemolysis]] include [[neonatal jaundice]], [[splenomegaly]], and [[Gallstones|pigment gallstones]].


Hyperbilirubinemia may be exacerbated by concomitant Gilbert syndrome. (See "Pathogenesis and etiology of unconjugated hyperbilirubinemia in the newborn".)
* Rarely, [[hemolysis]] may be severe enough to cause [[hematopoiesis|extramedullary hematopoiesis]] and/or [[growth delay]].<ref name="pmid2239921">{{cite journal| author=Bastion Y, Coiffier B, Felman P, Assouline D, Tigaud JD, Espinouse D et al.| title=Massive mediastinal extramedullary hematopoiesis in hereditary spherocytosis: a case report. | journal=Am J Hematol | year= 1990 | volume= 35 | issue= 4 | pages= 263-5 | pmid=2239921 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2239921  }}</ref><ref name="pmid21517821">{{cite journal| author=Smith J, Rahilly M, Davidson K| title=Extramedullary haematopoiesis secondary to hereditary spherocytosis. | journal=Br J Haematol | year= 2011 | volume= 154 | issue= 5 | pages= 543 | pmid=21517821 | doi=10.1111/j.1365-2141.2011.08692.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21517821  }}</ref>
* A small subset of these [[Child|children]] may be at risk for [[iron overload]] due to increased [[iron]] absorption and/or [[transfusions]], although the majority of [[Patient|patients]] with [[Hereditary spherocytosis|hereditary spherocytosis]] do not develop [[iron overload]].
* Other [[rare]] [[Complication (medicine)|complications]] that have been reported include [[Leg ulcer|leg ulcers]], [[priapism]], [[neuromuscular]] [[Disorder (medicine)|disorders]], [[cardiac disease]], and [[gout]]; in some cases, these may represent coincidental rather than causal associations.<ref name="pmid189404652">{{cite journal| author=Perrotta S, Gallagher PG, Mohandas N| title=Hereditary spherocytosis. | journal=Lancet | year= 2008 | volume= 372 | issue= 9647 | pages= 1411-26 | pmid=18940465 | doi=10.1016/S0140-6736(08)61588-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18940465  }}</ref>


'''Splenomegaly''' — Splenomegaly is rare in neonates, but can often be seen in older children and adults with HS [83]. Early reports of family studies found palpable spleens in over three-fourths of affected members, but this may reflect a skewed population with the most severe disease. In these studies, the relationship between disease severity and splenic size was not linear.<ref name="pmid14315658">{{cite journal| author=MACKINNEY AA| title=HEREDITARY SPHEROCYTOSIS; CLINICAL FAMILY STUDIES. | journal=Arch Intern Med | year= 1965 | volume= 116 | issue= | pages= 257-65 | pmid=14315658 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14315658 }}</ref>
'''[[Neonatal jaundice]]''' — [[Hereditary spherocytosis|hereditary spherocytosis]] may present in the [[Neonatal|neonatal period]] with [[jaundice]] and [[hyperbilirubinemia]], and the [[serum]] [[bilirubin]] level may not peak until several days after [[birth]]. Some experts have proposed that [[Hereditary spherocytosis|hereditary spherocytosis]] is underdiagnosed as a [[Causality|cause]] of [[neonatal jaundice]]. A requirement for [[phototherapy]] and/or [[exchange transfusion]] during this period is common.<ref name="pmid19948573">{{cite journal| author=Christensen RD, Henry E| title=Hereditary spherocytosis in neonates with hyperbilirubinemia. | journal=Pediatrics | year= 2010 | volume= 125 | issue= 1 | pages= 120-5 | pmid=19948573 | doi=10.1542/peds.2009-0864 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19948573 }}</ref>  


●There is no evidence of an increased risk of splenic rupture.
'''[[Splenomegaly]]''' — [[Splenomegaly]] is [[rare]] in [[Infant|neonates]], but can often be seen in older [[Child|children]] and [[Adult|adults]] with [[Hereditary spherocytosis|hereditary spherocytosis]]. Early reports of [[family]] studies found [[Palpation|palpable]] [[spleen]] in over three-fourths of affected members, but this may reflect a [[Skew deviation|skewed]] [[population]] with the most severe [[disease]]. In these studies, the relationship between [[disease]] severity and [[Spleen|splenic]] size was not linear.<ref name="pmid14315658">{{cite journal| author=MACKINNEY AA| title=HEREDITARY SPHEROCYTOSIS; CLINICAL FAMILY STUDIES. | journal=Arch Intern Med | year= 1965 | volume= 116 | issue=  | pages= 257-65 | pmid=14315658 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14315658  }}</ref>


'''Pigment gallstones''' — Pigment (bilirubin) gallstones are common in individuals with HS and may be the presenting finding in adults. Gallstones are unlikely before the age of 10 years but are seen in as many as half of adults, especially those with more severe hemolysis [90]. Gallstones appear to be more common in individuals with Gilbert syndrome.<ref name="pmid10498597">{{cite journal| author=del Giudice EM, Perrotta S, Nobili B, Specchia C, d'Urzo G, Iolascon A| title=Coinheritance of Gilbert syndrome increases the risk for developing gallstones in patients with hereditary spherocytosis. | journal=Blood | year= 1999 | volume= 94 | issue= 7 | pages= 2259-62 | pmid=10498597 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10498597  }}</ref>  
'''Pigment gallstones''' — [[Bilirubin|Pigment (bilirubin)]] [[gallstones]] are common in individuals with [[Hereditary spherocytosis|hereditary spherocytosis]] and may be the presenting finding in [[Adult|adults]]. [[Gallstones]] are unlikely before the [[Ageing|age]] of 10 years but are seen in as many as half of [[Adult|adults]], especially those with more severe [[hemolysis]]. [[Gallstones]] appear to be more common in individuals with [[Gilbert syndrome]].<ref name="pmid10498597">{{cite journal| author=del Giudice EM, Perrotta S, Nobili B, Specchia C, d'Urzo G, Iolascon A| title=Coinheritance of Gilbert syndrome increases the risk for developing gallstones in patients with hereditary spherocytosis. | journal=Blood | year= 1999 | volume= 94 | issue= 7 | pages= 2259-62 | pmid=10498597 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10498597  }}</ref>  


Obstructive jaundice or cholecystitis is treated similarly to that in individuals without HS. If cholecystectomy is performed, it may be worthwhile to discuss whether splenectomy was also planned, as the procedures could be combined; however, splenectomy should not be routinely performed during cholecystectomy.<ref name="pmid24650472">{{cite journal| author=Ruparel RK, Bogert JN, Moir CR, Ishitani MB, Khan SP, Rodriguez V et al.| title=Synchronous splenectomy during cholecystectomy for hereditary spherocytosis: is it really necessary? | journal=J Pediatr Surg | year= 2014 | volume= 49 | issue= 3 | pages= 433-5 | pmid=24650472 | doi=10.1016/j.jpedsurg.2013.05.012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24650472  }}</ref>
* [[Obstructive jaundice]] or [[cholecystitis]] is treated similarly to that in individuals without [[Hereditary spherocytosis|hereditary spherocytosis]]. If [[cholecystectomy]] is performed, it may be worthwhile to discuss whether [[splenectomy]] was also planned, as the procedures could be combined; however, [[splenectomy]] should not be routinely performed during [[cholecystectomy]].<ref name="pmid24650472">{{cite journal| author=Ruparel RK, Bogert JN, Moir CR, Ishitani MB, Khan SP, Rodriguez V et al.| title=Synchronous splenectomy during cholecystectomy for hereditary spherocytosis: is it really necessary? | journal=J Pediatr Surg | year= 2014 | volume= 49 | issue= 3 | pages= 433-5 | pmid=24650472 | doi=10.1016/j.jpedsurg.2013.05.012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24650472  }}</ref>


==Prognosis==
==Prognosis==
* The [[prognosis]] of [[Patient|patients]] with [[hereditary spherocytosis]] is usually good with early [[diagnosis]], regular followup and management.<ref>{{Cite journal
| author = [[Yuki Tateno]], [[Ryoji Suzuki]] & [[Yukihiro Kitamura]]
| title = Previously undiagnosed hereditary spherocytosis in a patient with jaundice and pyelonephritis: a case report
| journal = [[Journal of medical case reports]]
| volume = 10
| issue = 1
| pages = 337
| year = 2016
| month = December
| doi = 10.1186/s13256-016-1144-8
| pmid = 27906107
}}</ref>
* [[Patient|Patients]] with [[hereditary spherocytosis]] may remain [[Diagnosis|undiagnosed]] for years if their [[hemolysis]] is mild.
* Overall, the long-term outlook for people with [[hereditary spherocytosis]] is usually good with treatment. However, it may depend on the severity of the [[Disease|condition]] in each person.
* People with very mild [[Hereditary spherocytosis|hereditary spherocytosis]] may not have any [[Medical sign|signs]] or [[Symptom|symptoms]] unless an environmental [[Trigger|"trigger"]] [[Causality|causes]] [[symptom]] onset. In many cases, no specific [[therapy]] is needed other than monitoring for  and watching for [[Medical sign|signs]] and [[Symptom|symptoms]]. Moderately and severely affected people are likely to benefit from [[splenectomy]].<ref name="pmid220550202">{{cite journal| author=Bolton-Maggs PH, Langer JC, Iolascon A, Tittensor P, King MJ, General Haematology Task Force of the British Committee for Standards in Haematology| title=Guidelines for the diagnosis and management of hereditary spherocytosis--2011 update. | journal=Br J Haematol | year= 2012 | volume= 156 | issue= 1 | pages= 37-49 | pmid=22055020 | doi=10.1111/j.1365-2141.2011.08921.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22055020  }}</ref>
* Most people who undergo [[splenectomy]] are able to maintain a normal [[hemoglobin]] level. However, people with severe [[Hereditary spherocytosis|hereditary spherocytosis]] may remain [[Anemia|anemic]] [[Splenectomy|post-splenectomy]], and may need [[blood transfusions]] during an [[infection]].
* In all people who undergo [[splenectomy]], there is a lifelong, increased risk of developing a life-threatening [[infection]] [[Sepsis|(sepsis)]]. Although most [[Sepsis|septic]] episodes have been observed in [[Child|children]] whose [[Spleen|spleens]] were removed in the first years of [[life]], older [[Child|children]] and [[Adult|adults]] also are [[Susceptible individual|susceptible]]. Fortunately, taking certain [[Precautionary principle|precautions]] can reduce this risk and can prevent minor [[Infection|infections]] from becoming [[life]] threatening.


==References==
==References==

Latest revision as of 21:14, 6 December 2018

Hereditary spherocytosis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Hereditary spherocytosis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Hereditary spherocytosis natural history, complications and prognosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Hereditary spherocytosis natural history, complications and prognosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Hereditary spherocytosis natural history, complications and prognosis

CDC on Hereditary spherocytosis natural history, complications and prognosis

Hereditary spherocytosis natural history, complications and prognosis in the news

Blogs on Hereditary spherocytosis natural history, complications and prognosis

Directions to Hospitals Treating Hereditary spherocytosis

Risk calculators and risk factors for Hereditary spherocytosis natural history, complications and prognosis

Please help WikiDoc by adding content here. It's easy! Click here to learn about editing.

Overview

Hereditary spherocytosis can present at any age with any severity, ranging from hydrops fetalis in utero through diagnosis in the ninth decade of life, with variable clinical course depending upon the severity of disease. Majority of affected individuals have mild or moderate hemolysis and known family history, making the diagnosis and treatment relatively easy. Complications include; jaundice, kernicterus, pigment gallstones, hemolytic, aplastic and megaloblastic crises, splenomegaly and leukemia. The prognosis is usually good with early diagnosis, regular followup and management. Patients with mild disease may develop symptoms only with environmental triggers. Many patients who undergo splenectomy are able to maintain normal hemoglobin levels, however patients with severe hereditary spherocytosis may remain anemic postsplenectomy and require regular blood transfusions. Postsplenectomy patients are at increased risk of life threatening infections (sepsis), therefore require vaccinations and antibiotics.

Natural History

Hemolytic anemia — A classification for hereditary spherocytosis has been developed based on the severity of anemia and markers of hemolysis (reticulocyte count and bilirubin) [7][8]; it characterizes patients as having one of the following:

Hereditary spherocytosis trait – Normal hemoglobin and reticulocyte count

●Mild hereditary spherocytosis (20 to 30 percent of cases) – Hemoglobin 11 to 15 g/dL; reticulocytes 3 to 6 percent; bilirubin 17 to 34 micromol/L

●Moderate hereditary spherocytosis (60 to 75 percent of cases) – Hemoglobin 8 to 12 g/dL; reticulocytes >6 percent; bilirubin >34 micromol/L

●Severe hereditary spherocytosis (5 percent of cases) – Hemoglobin 6 to 8 g/dL; reticulocytes >10 percent; bilirubin >51 micromol/L

Complications

Complications of hemolysis — Common complications of hemolysis include neonatal jaundice, splenomegaly, and pigment gallstones.

Neonatal jaundice — hereditary spherocytosis may present in the neonatal period with jaundice and hyperbilirubinemia, and the serum bilirubin level may not peak until several days after birth. Some experts have proposed that hereditary spherocytosis is underdiagnosed as a cause of neonatal jaundice. A requirement for phototherapy and/or exchange transfusion during this period is common.[17]

Splenomegaly — Splenomegaly is rare in neonates, but can often be seen in older children and adults with hereditary spherocytosis. Early reports of family studies found palpable spleen in over three-fourths of affected members, but this may reflect a skewed population with the most severe disease. In these studies, the relationship between disease severity and splenic size was not linear.[18]

Pigment gallstones — Pigment (bilirubin) gallstones are common in individuals with hereditary spherocytosis and may be the presenting finding in adults. Gallstones are unlikely before the age of 10 years but are seen in as many as half of adults, especially those with more severe hemolysis. Gallstones appear to be more common in individuals with Gilbert syndrome.[19]

Prognosis

References

  1. Olga Ciepiela (2018). "Old and new insights into the diagnosis of hereditary spherocytosis". Annals of translational medicine. 6 (17): 339. doi:10.21037/atm.2018.07.35. PMID 30306078. Unknown parameter |month= ignored (help)
  2. F. Delhommeau, T. Cynober, P. O. Schischmanoff, P. Rohrlich, J. Delaunay, N. Mohandas & G. Tchernia (2000). "Natural history of hereditary spherocytosis during the first year of life". Blood. 95 (2): 393–397. PMID 10627440. Unknown parameter |month= ignored (help)
  3. Perrotta, Silverio; Gallagher, Patrick G; Mohandas, Narla (2008). "Hereditary spherocytosis". The Lancet. 372 (9647): 1411–1426. doi:10.1016/S0140-6736(08)61588-3. ISSN 0140-6736.
  4. Perrotta S, Gallagher PG, Mohandas N (2008). "Hereditary spherocytosis". Lancet. 372 (9647): 1411–26. doi:10.1016/S0140-6736(08)61588-3. PMID 18940465.
  5. Whitfield CF, Follweiler JB, Lopresti-Morrow L, Miller BA (1991). "Deficiency of alpha-spectrin synthesis in burst-forming units-erythroid in lethal hereditary spherocytosis". Blood. 78 (11): 3043–51. PMID 1954389.
  6. Eber SW, Armbrust R, Schröter W (1990). "Variable clinical severity of hereditary spherocytosis: relation to erythrocytic spectrin concentration, osmotic fragility, and autohemolysis". J Pediatr. 117 (3): 409–16. PMID 2391596.
  7. Bolton-Maggs PH, Stevens RF, Dodd NJ, Lamont G, Tittensor P, King MJ; et al. (2004). "Guidelines for the diagnosis and management of hereditary spherocytosis". Br J Haematol. 126 (4): 455–74. doi:10.1111/j.1365-2141.2004.05052.x. PMID 15287938.
  8. Bolton-Maggs PH, Stevens RF, Dodd NJ, Lamont G, Tittensor P, King MJ; et al. (2004). "Guidelines for the diagnosis and management of hereditary spherocytosis". Br J Haematol. 126 (4): 455–74. doi:10.1111/j.1365-2141.2004.05052.x. PMID 15287938.
  9. Christensen RD, Yaish HM, Gallagher PG (2015). "A pediatrician's practical guide to diagnosing and treating hereditary spherocytosis in neonates". Pediatrics. 135 (6): 1107–14. doi:10.1542/peds.2014-3516. PMC 4444801. PMID 26009624.
  10. Bolton-Maggs PH, Langer JC, Iolascon A, Tittensor P, King MJ, General Haematology Task Force of the British Committee for Standards in Haematology (2012). "Guidelines for the diagnosis and management of hereditary spherocytosis--2011 update". Br J Haematol. 156 (1): 37–49. doi:10.1111/j.1365-2141.2011.08921.x. PMID 22055020.
  11. Sayeeda Huq, Mark A. C. Pietroni, Hafizur Rahman & Mohammad Tariqul Alam (2010). "Hereditary spherocytosis". Journal of health, population, and nutrition. 28 (1): 107–109. PMID 20214092. Unknown parameter |month= ignored (help)
  12. Friedman, Ellen Wolkin; Williams, Jeannine C.; van Hook, Lucille (1988). "Hereditary spherocytosis in the elderly". The American Journal of Medicine. 84 (3): 513–516. doi:10.1016/0002-9343(88)90275-6. ISSN 0002-9343.
  13. Guitton, C.; Garçon, L.; Cynober, T.; Gauthier, F.; Tchernia, G.; Delaunay, J.; Leblanc, T.; Thuret, I.; Bader-Meunier, B. (2008). "Sphérocytose héréditaire : recommandations pour le diagnostic et la prise en charge chez l'enfant". Archives de Pédiatrie. 15 (9): 1464–1473. doi:10.1016/j.arcped.2008.04.023. ISSN 0929-693X.
  14. Bastion Y, Coiffier B, Felman P, Assouline D, Tigaud JD, Espinouse D; et al. (1990). "Massive mediastinal extramedullary hematopoiesis in hereditary spherocytosis: a case report". Am J Hematol. 35 (4): 263–5. PMID 2239921.
  15. Smith J, Rahilly M, Davidson K (2011). "Extramedullary haematopoiesis secondary to hereditary spherocytosis". Br J Haematol. 154 (5): 543. doi:10.1111/j.1365-2141.2011.08692.x. PMID 21517821.
  16. Perrotta S, Gallagher PG, Mohandas N (2008). "Hereditary spherocytosis". Lancet. 372 (9647): 1411–26. doi:10.1016/S0140-6736(08)61588-3. PMID 18940465.
  17. Christensen RD, Henry E (2010). "Hereditary spherocytosis in neonates with hyperbilirubinemia". Pediatrics. 125 (1): 120–5. doi:10.1542/peds.2009-0864. PMID 19948573.
  18. MACKINNEY AA (1965). "HEREDITARY SPHEROCYTOSIS; CLINICAL FAMILY STUDIES". Arch Intern Med. 116: 257–65. PMID 14315658.
  19. del Giudice EM, Perrotta S, Nobili B, Specchia C, d'Urzo G, Iolascon A (1999). "Coinheritance of Gilbert syndrome increases the risk for developing gallstones in patients with hereditary spherocytosis". Blood. 94 (7): 2259–62. PMID 10498597.
  20. Ruparel RK, Bogert JN, Moir CR, Ishitani MB, Khan SP, Rodriguez V; et al. (2014). "Synchronous splenectomy during cholecystectomy for hereditary spherocytosis: is it really necessary?". J Pediatr Surg. 49 (3): 433–5. doi:10.1016/j.jpedsurg.2013.05.012. PMID 24650472.
  21. Yuki Tateno, Ryoji Suzuki & Yukihiro Kitamura (2016). "Previously undiagnosed hereditary spherocytosis in a patient with jaundice and pyelonephritis: a case report". Journal of medical case reports. 10 (1): 337. doi:10.1186/s13256-016-1144-8. PMID 27906107. Unknown parameter |month= ignored (help)
  22. Bolton-Maggs PH, Langer JC, Iolascon A, Tittensor P, King MJ, General Haematology Task Force of the British Committee for Standards in Haematology (2012). "Guidelines for the diagnosis and management of hereditary spherocytosis--2011 update". Br J Haematol. 156 (1): 37–49. doi:10.1111/j.1365-2141.2011.08921.x. PMID 22055020.

Template:WH Template:WS