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Review
. 2023 Jan 27;102(4):e32708.
doi: 10.1097/MD.0000000000032708.

A large family of hereditary spherocytosis and a rare case of hereditary elliptocytosis with a novel SPTA1 mutation underdiagnosed in Taiwan: A case report and literature review

Yu-Hung Shih  1 , Ying-Chih Huang  2 , Ching-Yeh Lin  1 , Hsuan-Yu Lin  1 , Su-Feng Kuo  3 , Jen-Shiou Lin  3 , Ming-Ching Shen  1   4
Affiliations
Review

A large family of hereditary spherocytosis and a rare case of hereditary elliptocytosis with a novel SPTA1 mutation underdiagnosed in Taiwan: A case report and literature review

Yu-Hung Shih et al. Medicine (Baltimore). .

Abstract

Rationale: Hereditary spherocytosis (HS) has a defect in the vertically connected proteins on the cell membrane of red blood cells (RBC). Hereditary elliptocytosis (HE) has a defect in proteins that connect the cell membrane horizontally. We reported two families of RBC membrane disorders in Taiwanese, one was HS and the other was HE.

Patient concerns: Case 1. A 19-year-old male student with chronic jaundice and splenomegaly. His mother, maternal uncle, grandmother, and many members of older generations also had splenomegaly and underwent splenectomy. Case 2. A 40-year-old man has experienced pallor and jaundice since the age of 20 and was found to have splenomegaly, and gall bladder stones in the older age. His younger sister also had pallor and jaundice for a long time.

Diagnoses: In case 1, a peripheral blood smear showed 20% spherocytes. Eosin-5-maleimide labeled RBC by flow cytometry showed a result of 30.6 MCF (cutoff value: 45.5 MCF). He was diagnosed with HS. The gene analysis identified a heterozygous mutation with c.166A > G (p.Lys56Glu) in the SLC4A1 gene in this proband, his mother, and maternal uncle. In case 2, more than 40% of ellipsoid RBC present in the peripheral blood smear. He was diagnosed with HE. Genetic analysis of the SPTA1 gene identified a novel heterozygous exon2, c.86A > C, p.Gln29Prol mutation.

Interventions: The two patients had compensated anemia, clinical follow-up instead of splenectomy was done.

Outcomes: The two patients had normal daily activities and lives.

Lessons: We reported two Taiwanese families, one was hereditary spherocytosis affected by a heterozygous mutation with c.166A > G (p.Lys56Glu) in SLC4A1, and the other was hereditary elliptocytosis caused by a novel heterozygous SPTA1 gene mutation, c. 86A > C, p.Gln29Prol. These 2 seemingly common hereditary red blood cell membrane protein defects induced by hemolysis are usually underdiagnosed or misdiagnosed.

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Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Representation of peripheral blood smear. (A) Spherocytosis in the case 1 with HS. (B) Elliptocytosis in the case 2 with HE.
Figure 2.
Figure 2.
Pedigree of the Family. Splenomegaly was found in 9 family members and 6 of these members were splenectomized.
See this image and copyright information in PMC

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