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$Unique_ID{BRK03464}
$Pretitle{}
$Title{Anemia, Hereditary Spherocytic Hemolytic}
$Subject{Anemia, Hereditary Spherocytic Hemolytic Spherocytosis Hereditary
Spherocytosis HS SPH2 Congenital Hemolytic Jaundice Congenital Spherocytic
Anemia Acholuric Jaundice Chronic Acholuric Jaundice Congenital Hemolytic
Anemia Minkowski-Chauffard Syndrome Spherocytic Anemia Icterus (Chronic
Familial) Hereditary Nonspherocytic Hemolytic Anemia Thalassemia Major
Thalassemia Minor Anemias (General)}
$Volume{}
$Log{}
Copyright (C) 1986, 1987, 1988, 1989, 1990, 1993 National Organization
for Rare Disorders, Inc.
81:
Anemia, Hereditary Spherocytic Hemolytic
** IMPORTANT **
It is possible that the main title of the article (Hereditary Spherocytic
Hemolytic Anemia) is not the name you expected. Please check the SYNONYMS
listing to find the alternate name and disorder subdivisions covered by this
article.
Synonyms
Spherocytosis
Hereditary Spherocytosis
HS
SPH2
Congenital Hemolytic Jaundice
Congenital Spherocytic Anemia
Acholuric Jaundice
Chronic Acholuric Jaundice
Congenital Hemolytic Anemia
Minkowski-Chauffard Syndrome
Spherocytic Anemia
Icterus (Chronic Familial)
Information on the following diseases can be found in the Related
Disorders section of this report:
Hereditary Nonspherocytic Hemolytic Anemia
Thalassemia Major
Thalassemia Minor
Anemias (General)
General Discussion
** REMINDER **
The Information contained in the Rare Disease Database is provided for
educational purposes only. It should not be used for diagnostic or treatment
purposes. If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section of this report.
Hereditary Spherocytic Hemolytic Anemia is a rare blood disorder
characterized by defects within (intracorpuscular) red blood cells that
result in a shortened survival time for these cells. Red blood cells
(erythrocytes) normally circulate for a few months, and when they die off
they are replaced by new erythrocytes. However, in Hereditary Spherocytic
Hemolytic Anemia the cells die prematurely. They also have low amounts of
fats (lipid) in the cell membranes and a smaller than normal amount of
surface area. The red blood cells are sphere-shaped (spherocytic) making it
difficult for them to pass through the spleen, resulting in the early
destruction of these cells (hemolysis). The sphere-shape of the red blood
cells is the hallmark of Hereditary Spherocytic Hemolytic Anemia and it can
be identified under a microscope. This disorder is caused by an inherited
metabolic defect.
Symptoms
Hereditary Spherocytic Hemolytic Anemia may be present at birth or may not
become apparent for years. The symptoms of this disorder vary greatly from
one person to another. In many people the symptoms are so mild that the
disease is not diagnosed.
Symptoms of Hereditary Spherocytic Hemolytic Anemia may include excessive
tiredness and a moderate persistent yellow appearance to the skin (jaundice).
The onset of puberty may be delayed in children with Hereditary Spherocytic
Hemolytic Anemia. Some children may experience abdominal discomfort and have
an abnormally enlarged spleen (splenomegaly).
An infection is the most common cause of the temporary failure of the
bone marrow to produce blood components (aplastic crisis) in people with
Hereditary Spherocytic Hemolytic Anemia. This crisis results in a temporary
deficiency of red blood cell production. Trauma or pregnancy may make the
aplastic crisis worse. Symptoms of an aplastic crisis may include fever,
headache, abdominal pain, profound loss of appetite (anorexia), vomiting, and
fatigue. Children who are experiencing an aplastic crisis may also have nose
bleeds (epistaxis).
Occasionally children with Hereditary Spherocytic Hemolytic Anemia have
an abnormally enlarged liver (hepatomegaly), stones in the gall bladder
(cholelithiasis), and/or leg ulcers. In some cases deformities of the
anatomy are present at birth and may include more than the normal number of
fingers and/or toes (polydactylism), and/or a "tower-shaped" skull.
Hemolytic Anemias, including Hereditary Spherocytic Hemolytic Anemia,
have two distinct laboratory findings: a reduction in the life span of red
blood cells and the retention of iron within the body particularly in those
cells that have the ability to dispose of wastes and toxins
(reticuloendothelial system or RES). In all hemolytic anemias, there is
excessive destruction of red blood cells.
Causes
Hereditary Spherocytic Hemolytic Anemia is an inborn error of metabolism that
can be inherited as an autosomal dominant or autosomal recessive genetic
trait. Human traits, including the classic genetic diseases, are the product
of the interaction of two genes, one received from the father and one from
the mother. In dominant disorders a single copy of the disease gene
(received from either the mother or father) will be expressed "dominating"
the other normal gene and resulting in the appearance of the disease. The
risk of transmitting the disorder from affected parent to offspring is fifty
percent for each pregnancy regardless of the sex of the resulting child.
The more severe forms of Hereditary Spherocytic Hemolytic Anemia are
inherited as autosomal recessive genetic traits. In recessive disorders, the
condition does not appear unless a person inherits the same defective gene
for the same trait from each parent. If one receives one normal gene and one
gene for the disease, the person will be a carrier for the disease, but
usually will not show symptoms. The risk of transmitting the disease to the
children of a couple, both of whom are carriers for a recessive disorder, is
twenty-five percent. Fifty percent of their children will be carriers, but
healthy as described above. Twenty-five percent of their children will
receive both normal genes, one from each parent, and will be genetically
normal.
Usually people with Hereditary Spherocytic Hemolytic Anemia have a family
history of anemia, jaundice, or spleen enlargement (splenomegaly). At times,
other family members can be identified with this disorder, but in other cases
people with Hereditary Spherocytic Hemolytic Anemia may have no family
history of the disorder that can be traced.
The symptoms of Hereditary Spherocytic Hemolytic Anemia develop due to
the abnormality of the red blood cell membrane. The defective gene that
causes Hereditary Spherocytic Hemolytic Anemia is located on the short arm of
chromosome 8.
Affected Population
Hereditary Spherocytic Hemolytic Anemia is a rare disorder that affects males
and females in equal numbers. This disorder occurs most frequently in people
of Northern European heritage with a prevalence of approximately 1 in 5,000
people. However, this disorder also occurs in other populations at a lower
prevalence rate.
Related Disorders
Symptoms of the following disorders can be similar to those of Hereditary
Hemolytic Spherocytic Anemia. Comparisons may be useful for a differential
diagnosis:
Hereditary Nonspherocytic Hemolytic Anemia is a group of rare inherited
blood disorders characterized by defective red blood cells that are not
sphere-shaped. Symptoms may include moderate anemia, recurrent yellow
appearance to the skin (jaundice), and an abnormally large spleen
(splenomegaly) and/or liver (hepatomegaly). These symptoms usually occur in
childhood. (For more information on this disorder, choose "Hereditary
Hemolytic Nonspherocytic Anemia" as your search term in the Rare Disease
Database.)
Thalassemia Major is a rare blood disorder characterized by a marked
increase in F hemoglobin and a decrease in the production of certain oxygen
carrying proteins in red blood cells. The symptoms of this disorder
typically occur very suddenly in infancy or early childhood. These may
include generalized weakness (malaise), an upset stomach (dyspepsia), and/or
heart palpitations. Children may have a yellow appearance to their skin
(jaundice), leg ulcers, and/or an abnormally enlarged liver (hepatomegaly) or
spleen (splenomegaly). (For more information on this disorder, choose
"Thalassemia Major" as your search term in the Rare Disease Database.)
Thalassemia Minor is a relatively mild form of anemia that is typically
present at birth. It is inherited as an autosomal recessive genetic trait.
Constant fatigue may be the only symptom of this disorder. However, if
anemia becomes severe, the spleen may become slightly enlarged
(splenomegaly) and there may be a pale color to the skin. Occasionally a
child with Thalassemia Minor may complain of pain in the left upper side of
the abdomen. This disorder may be aggravated by stress, infections,
malnutrition, and/or pregnancy. (For more information on this disorder,
choose "Thalassemia Minor" as your search term in the Rare Disease Database).
Spherocytic red blood cells may also occur in Hemoglobin C Disease, drug
induced Hemolytic Anemias, and in people who have alcoholism. They may also
be present in individuals who experience serious burns on their bodies.
Other types of anemias include: Aplastic Anemia, Megaloblastic Anemia,
Warm Antibody Hemolytic Anemia, Cold Antibody Hemolytic Anemia, Acquired
Autoimmune Hemolytic Anemia, Pernicious Anemia, Folic Acid Deficiency Anemia,
Blackfan-Diamond Anemia, Sickle Cell Anemia, and Fanconi's Anemia. (For
information on other types of Anemias, choose "Anemia" as your search term in
the Rare Disease Database.)
Therapies: Standard
Hereditary Spherocytic Hemolytic Anemia usually has a long, chronic course.
The only currently recognized specific treatment for this disorder is the
removal of the spleen (splenectomy). This surgery is typically performed in
an individual with this disorder who is under the age of 45 years and has had
jaundice, ongoing pain in the upper right abdomen (biliary colic), and a
number of aplastic crises. Removal of the spleen should be avoided in
children under age 5 years because of the risk of overwhelming bacterial
infection. Following the surgery the symptoms typically disappear.
During an aplastic crisis, a person with Hereditary Spherocytic Hemolytic
Anemia should seek immediate medical attention. Blood transfusions may be
necessary to prevent the collapse of the cardiovascular system. If the
crisis is the result of an infection, antibiotic treatment may be necessary.
Genetic counseling will be of benefit for people with Hereditary
Spherocytic Hemolytic Anemia and their families. Other treatment is
symptomatic and supportive.
Therapies: Investigational
Studies are being conducted in the use of immunoglobulin (human) as a
treatment for Hereditary Spherocytic Hemolytic Anemia. Further investigation
is needed to determine the long-term safety and effectiveness of this
treatment.
This disease entry is based upon medical information available through
June 1993. Since NORD's resources are limited, it is not possible to keep
every entry in the Rare Disease Database completely current and accurate.
Please check with the agencies listed in the Resources section for the most
current information about this disorder.
Resources
For more information on Hereditary Spherocytic Hemolytic Anemia, please
contact:
National Organization for Rare Disorders (NORD)
P.O. Box 8923
New Fairfield, CT 06812-1783
(203) 746-6518
NIH/National Heart, Lung, & Blood Institute (NHLBI)
9000 Rockville Pike
Bethesda, MD 20892
(301) 496-4236
For Genetic Information and Genetic Counseling Referrals:
March of Dimes Birth Defects Foundation
1275 Mamaroneck Avenue
White Plains, NY 10605
(914) 428-7100
Alliance of Genetic Support Groups
35 Wisconsin Circle, Suite 440
Chevy Chase, MD 20815
(800) 336-GENE
(301) 652-5553
References
MENDELIAN INHERITANCE IN MAN, 10th Ed.: Victor A. McKusick, Editor: Johns
Hopkins University Press, 1992. Pp. 1025-28, 1702.
THE METABOLIC BASIS OF INHERITED DISEASE, 6th Ed.: Charles R. Scriver, et
al., Editors; McGraw Hill, 1989. P. 362.
CECIL TEXTBOOK OF MEDICINE, 19th Ed.: James B. Wyngaarden, and Lloyd H.
Smith, Jr., Editors; W.B. Saunders Co., 1990. Pp. 858-860.
THE MERCK MANUAL, 16th Ed.: Robert Berkow Ed.; Merck Research
Laboratories, 1992. Pp. 1167, 1999.
HEMATOLOGY, 4th Ed,: William J. Williams, et al,; Editors; McGraw-Hill,
Inc., 1990. Pp. 558-569.
BIRTH DEFECTS ENCYCLOPEDIA, Mary Louise Buyse, M.D., Editor-In-Chief;
Blackwell Scientific Publications, 1990. Pp. 1573-75.
HOMOZYGOSITY FOR DOMINANT FORM OF HEREDITARY SPHEROCYTOSIS. F. Duru; Br J
Heamotol (Nov 1992; 82(3)). Pp. 596-600.
CURRENT PROBLEMS IN HAEMATOLOGY. 2: HEREDITARY SPHEROCYTOSIS. J.C.
Smiley; J Clin Pathol (Jun 1991; 44(6)). Pp. 441-44.
SPLENIC SEQUESTRATION ASSOCIATED WITH SICKLE CELL TRAIT AND HEREDITARY
SPHEROCYTOSIS. Y.M. Yang; Am J Hematol (Jun 1992; 40(2)). Pp. 110-6.