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Hereditary Spherocytosis – Causes, Symptoms and Treatment

Hereditary spherocytosis is an inherited disorder of red blood cells in which they take on a spherical rather than a normal disc shape, causing them to be broken down prematurely.

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Things worth knowing about "Hereditary Spherocytosis"

Hereditary spherocytosis is an inherited disorder of red blood cells in which they take on a spherical rather than a normal disc shape, causing them to be broken down prematurely.

What is Hereditary Spherocytosis?

Hereditary spherocytosis (HS) is one of the most common inherited red blood cell disorders in Europe and North America. Due to defects in certain membrane proteins, red blood cells (erythrocytes) assume a characteristic spherical shape – hence the name spherocytosis (from Greek sphaira = sphere). These abnormally shaped cells are less flexible than healthy red blood cells and are prematurely destroyed in the spleen, leading to hemolytic anemia (a reduction in red blood cells due to excessive breakdown).

Causes and Genetics

The condition is caused by mutations in genes encoding structural proteins of the erythrocyte membrane. Commonly affected proteins include:

Ankyrin (the most frequently affected protein, accounting for approximately 40–65% of cases)
Spectrin (alpha- and beta-spectrin)
Band 3 protein
Protein 4.2

In most cases (approximately 75%), hereditary spherocytosis follows an autosomal dominant inheritance pattern, meaning a mutation in just one copy of the gene is sufficient to cause the disorder. Less commonly, an autosomal recessive pattern is observed. In about 25% of cases, the condition arises from a de novo mutation with no family history.

Symptoms

The severity of hereditary spherocytosis varies considerably, ranging from mild, asymptomatic cases to severe anemia. Common symptoms include:

Anemia: Pallor, fatigue, weakness, and reduced exercise tolerance
Jaundice: Yellowing of the skin and eyes due to elevated bilirubin levels from increased cell breakdown
Splenomegaly: Enlargement of the spleen as it works to remove abnormal red blood cells
Gallstones: Pigment gallstones caused by high bilirubin production, sometimes occurring even in childhood
Aplastic crises: Temporary suppression of red blood cell production, often triggered by infections such as Parvovirus B19

In newborns, pronounced neonatal jaundice may be the first sign of the condition.

Diagnosis

Diagnosis is based on a combination of clinical assessment, laboratory tests, and, when necessary, genetic testing:

Complete blood count: Reveals hemolytic anemia with elevated MCHC (mean corpuscular hemoglobin concentration) and increased reticulocyte count
Blood smear: Microscopic identification of spherocytes – small, round, densely staining red blood cells lacking the central pallor seen in normal cells
Eosin-5-maleimide (EMA) binding test: A highly sensitive and specific flow cytometry-based test for detecting membrane protein defects
Osmotic fragility test: An older method that measures the increased susceptibility of spherocytes to hypotonic solutions
Family history: A family pattern of the condition is an important diagnostic indicator
Genetic testing: Used to confirm the diagnosis in ambiguous cases

Treatment

Mild to Moderate Cases

Mild forms often require no specific treatment. However, regular folic acid supplementation is recommended, as the increased demand for new red blood cell production raises folate requirements. Routine medical follow-up is important to detect complications early.

Severe Cases and Splenectomy

In severe cases with marked anemia or frequent aplastic crises, splenectomy (surgical removal of the spleen) may be considered. Since the spleen is the primary site of abnormal red blood cell destruction, its removal significantly improves anemia. However, splenectomy increases the risk of serious infections with encapsulated bacteria (Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis), making thorough vaccination and often lifelong antibiotic prophylaxis necessary. In children, surgery is generally deferred until after the age of 6 years.

Additional Measures

Blood transfusions: For severe anemia or aplastic crises
Cholecystectomy: Surgical removal of the gallbladder for symptomatic gallstones
Phototherapy or exchange transfusion: For severe neonatal jaundice

Prognosis

With appropriate management, the prognosis of hereditary spherocytosis is generally good. Most people with this condition lead normal lives. However, the risk of complications – particularly following splenectomy – must be monitored throughout life. Regular follow-up with a hematologist is recommended.

References

Bolton-Maggs PH, Langer JC, Iolascon A et al. – Guidelines for the diagnosis and management of hereditary spherocytosis. British Journal of Haematology, 156(1):37–49, 2012.
Perrotta S, Gallagher PG, Mohandas N – Hereditary spherocytosis. Lancet, 372(9647):1411–1426, 2008.
Gallagher PG – Hereditary Elliptocytosis and Spherocytosis. In: Hematology: Basic Principles and Practice, 7th ed., Elsevier, 2018.

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