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Hereditary spherocytosis type 4(SPH4; HS4)

MedGen UID:
436375
Concept ID:
C2675212
Disease or Syndrome
Synonyms: Hemolytic Anemia due to Band 3 Montefiore; SLC4A1-Related Hereditary Spherocytosis; SLC4A1-Related Spherocytosis; Spherocytosis type 4
 
Gene (location): SLC4A1 (17q21.31)
 
Monarch Initiative: MONDO:0012981
OMIM®: 612653

Definition

People with the mild form may have very mild anemia or sometimes have no symptoms. People with the moderate form typically have anemia, jaundice, and splenomegaly. Many also develop gallstones. The signs and symptoms of moderate hereditary spherocytosis usually appear in childhood. Individuals with the moderate/severe form have all the features of the moderate form but also have severe anemia. Those with the severe form have life-threatening anemia that requires frequent blood transfusions to replenish their red blood cell supply. They also have severe splenomegaly, jaundice, and a high risk for developing gallstones. Some individuals with the severe form have short stature, delayed sexual development, and skeletal abnormalities.

There are four forms of hereditary spherocytosis, which are distinguished by the severity of signs and symptoms. They are known as the mild form, the moderate form, the moderate/severe form, and the severe form. It is estimated that 20 to 30 percent of people with hereditary spherocytosis have the mild form, 60 to 70 percent have the moderate form, 10 percent have the moderate/severe form, and 3 to 5 percent have the severe form.

Hereditary spherocytosis is a condition that affects red blood cells. People with this condition typically experience a shortage of red blood cells (anemia), yellowing of the eyes and skin (jaundice), and an enlarged spleen (splenomegaly). Most newborns with hereditary spherocytosis have severe anemia, although it improves after the first year of life. Splenomegaly can occur anytime from early childhood to adulthood. About half of affected individuals develop hard deposits in the gallbladder called gallstones, which typically occur from late childhood to mid-adulthood. [from MedlinePlus Genetics]

Clinical features

From HPO
Jaundice
MedGen UID:
43987
Concept ID:
C0022346
Sign or Symptom
Yellow pigmentation of the skin due to bilirubin, which in turn is the result of increased bilirubin concentration in the bloodstream.
Hemolytic anemia
MedGen UID:
1916
Concept ID:
C0002878
Disease or Syndrome
A type of anemia caused by premature destruction of red blood cells (hemolysis).
Reticulocytosis
MedGen UID:
60089
Concept ID:
C0206160
Finding
An elevation in the number of reticulocytes (immature erythrocytes) in the peripheral blood circulation.
Spherocytosis
MedGen UID:
154301
Concept ID:
C0553720
Finding
The presence of erythrocytes that are sphere-shaped.
Increased red cell osmotic fragility
MedGen UID:
376594
Concept ID:
C1849478
Finding
Splenomegaly
MedGen UID:
52469
Concept ID:
C0038002
Finding
Abnormal increased size of the spleen.
Hyperbilirubinemia
MedGen UID:
86321
Concept ID:
C0311468
Finding
An increased amount of bilirubin in the blood.

Professional guidelines

PubMed

EVANS RS, DUANE R
Calif Med 1949 Apr;70(4):244-51. PMID: 18116227Free PMC Article

Recent clinical studies

Etiology

Aly NH, Elalfy MS, Elhabashy SA, Mowafy NM, Russo R, Andolfo I, Iolascon A, Ragab IA
Blood Cells Mol Dis 2023 Nov;103:102779. Epub 2023 Jul 16 doi: 10.1016/j.bcmd.2023.102779. PMID: 37558589
Zaninoni A, Fermo E, Vercellati C, Marcello AP, Barcellini W, Bianchi P
Front Immunol 2020;11:1309. Epub 2020 Jun 23 doi: 10.3389/fimmu.2020.01309. PMID: 32655575Free PMC Article
Das A, Bansal D, Das R, Trehan A, Marwaha RK
Indian Pediatr 2014 Feb;51(2):139-41. doi: 10.1007/s13312-014-0348-5. PMID: 24632695
de Lagausie P, Bonnard A, Benkerrou M, Rorlich P, de Ribier A, Aigrain Y
Surg Endosc 2004 Jan;18(1):80-2. Epub 2003 Nov 21 doi: 10.1007/s00464-003-9048-2. PMID: 14625739
Hansen K, Singer DB
Pediatr Dev Pathol 2001 Mar-Apr;4(2):105-21. doi: 10.1007/s100240010145. PMID: 11178626

Diagnosis

Aly NH, Elalfy MS, Elhabashy SA, Mowafy NM, Russo R, Andolfo I, Iolascon A, Ragab IA
Blood Cells Mol Dis 2023 Nov;103:102779. Epub 2023 Jul 16 doi: 10.1016/j.bcmd.2023.102779. PMID: 37558589
Das A, Bansal D, Das R, Trehan A, Marwaha RK
Indian Pediatr 2014 Feb;51(2):139-41. doi: 10.1007/s13312-014-0348-5. PMID: 24632695
Da Costa L, Galimand J, Fenneteau O, Mohandas N
Blood Rev 2013 Jul;27(4):167-78. Epub 2013 May 9 doi: 10.1016/j.blre.2013.04.003. PMID: 23664421
Tse WT, Lux SE
Br J Haematol 1999 Jan;104(1):2-13. doi: 10.1111/j.1365-2141.1999.01130.x. PMID: 10027705
Yawata Y, Kanzaki A, Inoue T, Ata K, Wada H, Okamoto N, Higo I, Yawata A, Sugihara T, Yamada O
Int J Hematol 1994 Jul;60(1):23-38. PMID: 7919236

Therapy

Glenthøj A, van Beers EJ, van Wijk R, Rab MAE, Groot E, Vejlstrup N, Toft N, Bendtsen SK, Petersen J, Helby J, Chermat F, Fenaux P, Kuo KHM
BMJ Open 2024 Jul 30;14(7):e083691. doi: 10.1136/bmjopen-2023-083691. PMID: 39079928Free PMC Article
Elbadry MI, Khaled SAA, Ahmed NM, Abudeif A, Abdelkareem RM, Ezeldin M, Tawfeek A
Br J Haematol 2021 May;193(4):827-840. Epub 2021 Apr 25 doi: 10.1111/bjh.17484. PMID: 33899219
Chen J, Zhou Y, Gao Y, Cao W, Sun H, Liu Y, Wang C
Hematology 2017 May;22(4):240-247. Epub 2016 Oct 3 doi: 10.1080/10245332.2016.1235673. PMID: 27696975
Englum BR, Rothman J, Leonard S, Reiter A, Thornburg C, Brindle M, Wright N, Heeney MM, Jason Smithers C, Brown RL, Kalfa T, Langer JC, Cada M, Oldham KT, Scott JP, St Peter SD, Sharma M, Davidoff AM, Nottage K, Bernabe K, Wilson DB, Dutta S, Glader B, Crary SE, Dassinger MS, Dunbar L, Islam S, Kumar M, Rescorla F, Bruch S, Campbell A, Austin M, Sidonio R, Blakely ML, Rice HE; Splenectomy in Congenital Hemolytic Anemia Consortium
J Pediatr Surg 2016 Jan;51(1):122-7. Epub 2015 Oct 23 doi: 10.1016/j.jpedsurg.2015.10.028. PMID: 26613837Free PMC Article
Hansen K, Singer DB
Pediatr Dev Pathol 2001 Mar-Apr;4(2):105-21. doi: 10.1007/s100240010145. PMID: 11178626

Prognosis

Elbadry MI, Khaled SAA, Ahmed NM, Abudeif A, Abdelkareem RM, Ezeldin M, Tawfeek A
Br J Haematol 2021 May;193(4):827-840. Epub 2021 Apr 25 doi: 10.1111/bjh.17484. PMID: 33899219
Lorand L, Iismaa SE
FASEB J 2019 Jan;33(1):3-12. doi: 10.1096/fj.201801544R. PMID: 30593123
Chen J, Zhou Y, Gao Y, Cao W, Sun H, Liu Y, Wang C
Hematology 2017 May;22(4):240-247. Epub 2016 Oct 3 doi: 10.1080/10245332.2016.1235673. PMID: 27696975
Ruparel RK, Bogert JN, Moir CR, Ishitani MB, Khan SP, Rodriguez V, Zarroug AE
J Pediatr Surg 2014 Mar;49(3):433-5. doi: 10.1016/j.jpedsurg.2013.05.012. PMID: 24650472
Werner B, Lindahl J
Scand J Clin Lab Invest 1980 Jun;40(4):319-24. doi: 10.3109/00365518009092650. PMID: 7414250

Clinical prediction guides

Wang WJ, Xie JD, Yao H, Ding ZX, Jiang AR, Ma L, Shen HJ, Chen SN
Clin Genet 2023 Jan;103(1):67-78. Epub 2022 Oct 21 doi: 10.1111/cge.14244. PMID: 36203343
Lorand L, Iismaa SE
FASEB J 2019 Jan;33(1):3-12. doi: 10.1096/fj.201801544R. PMID: 30593123
Chen J, Zhou Y, Gao Y, Cao W, Sun H, Liu Y, Wang C
Hematology 2017 May;22(4):240-247. Epub 2016 Oct 3 doi: 10.1080/10245332.2016.1235673. PMID: 27696975
Das A, Bansal D, Das R, Trehan A, Marwaha RK
Indian Pediatr 2014 Feb;51(2):139-41. doi: 10.1007/s13312-014-0348-5. PMID: 24632695
Yawata Y, Kanzaki A, Inoue T, Ata K, Wada H, Okamoto N, Higo I, Yawata A, Sugihara T, Yamada O
Int J Hematol 1994 Jul;60(1):23-38. PMID: 7919236

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