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Genotype–phenotype correlation in children with hereditary spherocytosis
Author(s) -
Tole Soumitra,
Dhir Priya,
Pugi Jakob,
Drury Luke J.,
Butchart Sheila,
Fantauzzi Michelle,
Langer Jacob C.,
Baker Jillian M.,
Blanchette Victor S.,
KirbyAllen Melanie,
Carcao Manuel D.
Publication year - 2020
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.16750
Subject(s) - splenectomy , hereditary spherocytosis , spherocytosis , medicine , phenotype , genotype , gastroenterology , hemolytic anemia , immunology , pediatrics , genetics , spleen , biology , gene
Summary Hereditary spherocytosis (HS) is a common inherited haemolytic anaemia attributed to disturbances in five different red cell membrane proteins. We performed a retrospective study of 166 children with HS and describe the clinical phenotype according to the genotype. In 160/166 (97%) children with HS a disease‐causing mutation was identified. Pathogenic variants in ANK1 , SPTB , SLC4A1 and SPTA1 were found in 49%, 33%, 13% and 5% of patients. Children with SLC4A1 ‐HS had the mildest phenotype, showing the highest haemoglobin ( P < 0·001), lowest reticulocyte counts ( P < 0·001) and lowest unconjugated bilirubin levels ( P = 0·006), and none required splenectomy in childhood ( P < 0·001). Conversely, children with autosomal recessive SPTA1 ‐HS had the most severe clinical phenotype, with almost all patients undergoing splenectomy in early childhood. Patients with ANK1 and SPTB variants showed a similar clinical phenotype. Within each gene, variant type or location did not predict disease severity or likelihood of splenectomy. Among patients with a genetic diagnosis, 47 (29%) underwent splenectomy (23 partial; 24 total) while 57 (36%) underwent cholecystectomy. Total splenectomy led to greater improvements in haemoglobin ( P = 0·02). Select use of genetic testing (especially in patients without a family history) may help predict clinical phenotype in childhood and guide family counselling.