Hereditary spherocytosis: Difference between revisions
imported>Michael Benjamin No edit summary |
imported>Anthony.Sebastian (add dict def hemolysis for reader) |
||
| (10 intermediate revisions by 6 users not shown) | |||
| Line 1: | Line 1: | ||
{{ | {{subpages}} | ||
{{TOC|right}} | |||
{{Infobox Disease | | |||
Name = Hereditary spherocytosis | | Name = Hereditary spherocytosis | | ||
ICD10 = D58.0 | | ICD10 = D58.0 | | ||
ICD9 = {{ICD9|282.0}} | | ICD9 = {{ICD9|282.0}} | | ||
}} | }} | ||
{{main|Spherocytosis}} | |||
'''Hereditary spherocytosis''' is a genetically-transmitted form of [[spherocytosis]], a [[hemolysis|hemolytic]] [[anemia]] characterized by the production of [[red blood cells]] that are sphere-shaped rather than donut-shaped, and, as a consequence, more prone to breakage and release of potentially toxic free hemoglobin into the blood plasma, a condition referred as [[hemolysis]]<ref>Hemolysis: the destruction of red blood cells and the release of the hemoglobin they contain. —[http://www.bing.com/Dictionary/search?q=define+hemolysis&FORM=DTPDIA Encarta World English Dictionary]</ref> | |||
This article covers aspects of [[spherocytosis]] specific to the hereditary form of the disorder. | |||
This article covers aspects of [[spherocytosis]] specific to the hereditary form of the disorder | |||
==Symptoms== | ==Symptoms== | ||
| Line 13: | Line 15: | ||
==Diagnosis== | ==Diagnosis== | ||
In a [[peripheral blood smear]], the abnormally small [[red blood cell]]s lacking the central pallor as seen in [[spherocytosis|non-hereditary spherocytosis]] is typically more marked in hereditary spherocytosis. | {{seealso|human iron metabolism}} | ||
In a [[peripheral blood smear]], the abnormally small [[red blood cell]]s lacking the central pallor as seen in [[spherocytosis|non-hereditary spherocytosis]] is typically more marked in hereditary spherocytosis. Other hereditary morphological variants of [[red blood cells]] include [[hereditary elliptocytosis]], [[pyropoikilocytosis]] and [[stomatocytosis]]. | |||
Other hereditary morphological variants of [[red blood cells]] include [[hereditary elliptocytosis]], [[pyropoikilocytosis]] and [[stomatocytosis]]. | |||
In longstanding cases and in patients who have taken [[iron]] supplementation or received numerous [[blood transfusion]]s, [[iron overload]] may be a significant problem, being a potential cause of [[cardiomyopathy]] and [[liver disease]]. Measuring iron stores is therefore considered part of the diagnostic approach to [[hereditary spherocytosis]]. | In longstanding cases and in patients who have taken [[iron]] supplementation or received numerous [[blood transfusion]]s, [[iron overload]] may be a significant problem, being a potential cause of [[cardiomyopathy]] and [[liver disease]]. Measuring iron stores is therefore considered part of the diagnostic approach to [[hereditary spherocytosis]]. | ||
| Line 22: | Line 23: | ||
Hereditary spherocytosis is an [[autosomal dominant]] trait, most commonly (though not exclusively) found in [[Northern European]] and [[Japanese]] families, although an estimated 25% of cases are due to spontaneous [[mutation]]s. A patient has a 50% chance of passing the disorder onto his/her offspring, presuming that his/her partner does not also carry the [[mutation]]. | Hereditary spherocytosis is an [[autosomal dominant]] trait, most commonly (though not exclusively) found in [[Northern European]] and [[Japanese]] families, although an estimated 25% of cases are due to spontaneous [[mutation]]s. A patient has a 50% chance of passing the disorder onto his/her offspring, presuming that his/her partner does not also carry the [[mutation]]. | ||
Hereditary spherocytosis is caused by a variety of molecular defects in the genes that code for [[spectrin]], [[ankyrin]], [[protein 4.1]], and other [[erythrocyte]] membrane proteins. These proteins are necessary to maintain the normal shape of an [[erythrocyte]], which is a biconcave disk. The protein that is most commonly defective is [[ankyrin]] | Hereditary spherocytosis is caused by a variety of molecular defects in the genes that code for [[spectrin]], [[ankyrin]], [[protein 4.1]], and other [[erythrocyte]] membrane proteins. These proteins are necessary to maintain the normal shape of an [[erythrocyte]], which is a biconcave disk. The protein that is most commonly defective is [[ankyrin]]. As the spleen normally targets abnormally shaped red cells (which are typically older), it also destroys [[spherocytes]]. | ||
Hereditary spherocytosis is associated with thromboembolic disease. 15/15 spherocytic mice showed signs of thrombosis in one 1997 study<ref>{{cite journal |author=Kaysser T, Wandersee N, Bronson R, Barker J |title=Thrombosis and secondary hemochromatosis play major roles in the pathogenesis of jaundiced and spherocytic mice, murine models for hereditary spherocytosis |journal=Blood |volume=90 |issue=11 |pages=4610-9 |year=1997 |pmid=9373273}}</ref>. A 1997 case report discussed the relationship between arterial thrombosis and hereditary spherocytosis<ref>{{cite journal |author=Nikol S, Huehns T, Kiefmann R, Höfling B |title=Excessive arterial thrombus in spherocytosis. A case report |journal=Angiology |volume=48 |issue=8 |pages=743-8 |year=1997 |pmid=9269145}}</ref> | |||
==Treatment== | ==Treatment== | ||
Acute symptoms of [[anemia]] or [[hyperbilirubinemia]] require treatment with [[blood transfusions]] or [[exchange transfusions]]. Chronic symptoms of [[anemia]] and [[splenomegaly]] may necessitate [[splenectomy]], the surgical removal of the [[spleen]]. Pharmacological or dietary [[iron]] supplementation may not be useful if the patient has [[iron overload]]. | Acute symptoms of [[anemia]] or [[hyperbilirubinemia]] require treatment with [[Whole blood and blood component transfusion|blood transfusions]] or [[exchange transfusions]]. Chronic symptoms of [[anemia]] and [[splenomegaly]] may necessitate [[splenectomy]], the surgical removal of the [[spleen]]. Pharmacological or dietary [[iron]] supplementation may not be useful if the patient has [[iron overload]]. | ||
[[Gene therapy]] using [[retrovirus|retroviral]] vectors to correct [[hereditary spherocytosis]] has been successful [[in vitro]]<ref>{{cite journal |author=Dooner G, Barker J, Gallagher P, Debatis M, Brown A, Forget B, Becker P |title=Gene transfer to ankyrin-deficient bone marrow corrects spherocytosis in vitro |journal=Exp Hematol |volume=28 |issue=7 |pages=765-74 |year=2000 |pmid=10907638}}</ref>; human trials have not been attempted as of February 2007. | [[Gene therapy]] using [[retrovirus|retroviral]] vectors to correct [[hereditary spherocytosis]] has been successful [[in vitro]]<ref>{{cite journal |author=Dooner G, Barker J, Gallagher P, Debatis M, Brown A, Forget B, Becker P |title=Gene transfer to ankyrin-deficient bone marrow corrects spherocytosis in vitro |journal=Exp Hematol |volume=28 |issue=7 |pages=765-74 |year=2000 |pmid=10907638}}</ref>; human trials have not been attempted as of February 2007. | ||
| Line 31: | Line 34: | ||
==Prevalence== | ==Prevalence== | ||
It is the most common (1 in 5,000 of Northern European ancestry) disorder of the red cell membrane. | It is the most common (1 in 5,000 of Northern European ancestry) disorder of the red cell membrane. | ||
==External links== | ==External links== | ||
| Line 47: | Line 44: | ||
* Kumar, Vinay, Abul Abbas, and Nelson Fausto. "Robbins and Cotran Pathologic Basis of Disease, 7th edition (2004)." | * Kumar, Vinay, Abul Abbas, and Nelson Fausto. "Robbins and Cotran Pathologic Basis of Disease, 7th edition (2004)." | ||
* Schneider, Arthur S. and Philip A. Stanzo. "Board Review Series: Pathology, 2nd edition (2002)." | * Schneider, Arthur S. and Philip A. Stanzo. "Board Review Series: Pathology, 2nd edition (2002)." | ||
<references/> | |||
Latest revision as of 22:24, 1 July 2010
| Hereditary spherocytosis | |
|---|---|
| ICD-10 | D58.0 |
| ICD-9 | 282.0 |
Hereditary spherocytosis is a genetically-transmitted form of spherocytosis, a hemolytic anemia characterized by the production of red blood cells that are sphere-shaped rather than donut-shaped, and, as a consequence, more prone to breakage and release of potentially toxic free hemoglobin into the blood plasma, a condition referred as hemolysis[1]
This article covers aspects of spherocytosis specific to the hereditary form of the disorder.
Symptoms
As in non-hereditary spherocytosis, the spleen's hemolysis results in observational symptoms of fatigue, pallor, and jaundice. See the article on spherocytosis for details.
Diagnosis
- See also: human iron metabolism
In a peripheral blood smear, the abnormally small red blood cells lacking the central pallor as seen in non-hereditary spherocytosis is typically more marked in hereditary spherocytosis. Other hereditary morphological variants of red blood cells include hereditary elliptocytosis, pyropoikilocytosis and stomatocytosis.
In longstanding cases and in patients who have taken iron supplementation or received numerous blood transfusions, iron overload may be a significant problem, being a potential cause of cardiomyopathy and liver disease. Measuring iron stores is therefore considered part of the diagnostic approach to hereditary spherocytosis.
Pathophysiology
Hereditary spherocytosis is an autosomal dominant trait, most commonly (though not exclusively) found in Northern European and Japanese families, although an estimated 25% of cases are due to spontaneous mutations. A patient has a 50% chance of passing the disorder onto his/her offspring, presuming that his/her partner does not also carry the mutation.
Hereditary spherocytosis is caused by a variety of molecular defects in the genes that code for spectrin, ankyrin, protein 4.1, and other erythrocyte membrane proteins. These proteins are necessary to maintain the normal shape of an erythrocyte, which is a biconcave disk. The protein that is most commonly defective is ankyrin. As the spleen normally targets abnormally shaped red cells (which are typically older), it also destroys spherocytes.
Hereditary spherocytosis is associated with thromboembolic disease. 15/15 spherocytic mice showed signs of thrombosis in one 1997 study[2]. A 1997 case report discussed the relationship between arterial thrombosis and hereditary spherocytosis[3]
Treatment
Acute symptoms of anemia or hyperbilirubinemia require treatment with blood transfusions or exchange transfusions. Chronic symptoms of anemia and splenomegaly may necessitate splenectomy, the surgical removal of the spleen. Pharmacological or dietary iron supplementation may not be useful if the patient has iron overload.
Gene therapy using retroviral vectors to correct hereditary spherocytosis has been successful in vitro[4]; human trials have not been attempted as of February 2007.
Prevalence
It is the most common (1 in 5,000 of Northern European ancestry) disorder of the red cell membrane.
External links
- Online Mendelian Inheritance in Man, OMIM®. Johns Hopkins University, Baltimore, MD. MIM Number: 182900. World Wide Web URL: http://omim.org/.
- A short article from WebMD
- A picture of spherocytes from Medline
- A detailed and technical (but good) article from eMedicine
References
- Kumar, Vinay, Abul Abbas, and Nelson Fausto. "Robbins and Cotran Pathologic Basis of Disease, 7th edition (2004)."
- Schneider, Arthur S. and Philip A. Stanzo. "Board Review Series: Pathology, 2nd edition (2002)."
- ↑ Hemolysis: the destruction of red blood cells and the release of the hemoglobin they contain. —Encarta World English Dictionary
- ↑ Kaysser T, Wandersee N, Bronson R, Barker J (1997). "Thrombosis and secondary hemochromatosis play major roles in the pathogenesis of jaundiced and spherocytic mice, murine models for hereditary spherocytosis". Blood 90 (11): 4610-9. PMID 9373273.
- ↑ Nikol S, Huehns T, Kiefmann R, Höfling B (1997). "Excessive arterial thrombus in spherocytosis. A case report". Angiology 48 (8): 743-8. PMID 9269145.
- ↑ Dooner G, Barker J, Gallagher P, Debatis M, Brown A, Forget B, Becker P (2000). "Gene transfer to ankyrin-deficient bone marrow corrects spherocytosis in vitro". Exp Hematol 28 (7): 765-74. PMID 10907638.