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{{Hereditary spherocytosis}}
== Overview==
== Overview==
The diagnosis of hereditary spherocytosis can be based on physical examination, complete blood count (CBC), reticulocyte count, medical history and specific tests including eosin-5-maleimide binding (EMA) test and acidified glycerol lysis time (AGLT) test. The diagnosis can be made at any age. EMA binding test has high sensitivity and specificity for the hereditary spherocytosis. Other tests include; osmotic fragility (OF) test, pink test and ektacytometry. Gel electrophoresis analysis of erythrocyte membranes is the method of choice for diagnosis of atypical cases.
The [[diagnosis]] of [[hereditary spherocytosis]] can be based on [[physical examination]], [[Complete blood count|complete blood count (CBC)]], [[Reticulocyte|reticulocyte count]], [[medical history]] and specific [[Test|tests]] including eosin-5-maleimide binding (EMA) [[test]] and acidified glycerol lysis time (AGLT) [[test]]. The [[diagnosis]] can be made at any [[Ageing|age]]. EMA binding [[test]] has high [[Sensitivity (tests)|sensitivity]] and [[Specificity (tests)|specificity]] for the [[hereditary spherocytosis]]. Other [[Test|tests]] include; osmotic fragility (OF) [[test]], pink [[test]] and ektacytometry. [[Gel electrophoresis]] analysis of [[Red blood cell|erythrocyte]] [[Membrane|membranes]] is the method of choice for [[diagnosis]] of atypical [[Disease|cases]].


== Diagnostic Criteria ==
== Diagnostic Criteria ==
* The diagnosis of hereditary spherocytosis can be based on the physical examination, complete red cell count, recticulocyte count, medical history and specific tests, preferentially, the EMA (eosin-5-maleimide binding) test and AGLT (acidified glycerol lysis time).<ref name="GuittonGarçon2008">{{cite journal|last1=Guitton|first1=C.|last2=Garçon|first2=L.|last3=Cynober|first3=T.|last4=Gauthier|first4=F.|last5=Tchernia|first5=G.|last6=Delaunay|first6=J.|last7=Leblanc|first7=T.|last8=Thuret|first8=I.|last9=Bader-Meunier|first9=B.|title=Sphérocytose héréditaire : recommandations pour le diagnostic et la prise en charge chez l’enfant|journal=Archives de Pédiatrie|volume=15|issue=9|year=2008|pages=1464–1473|issn=0929693X|doi=10.1016/j.arcped.2008.04.023}}</ref><ref>{{Cite journal
* The [[diagnosis]] of [[hereditary spherocytosis]] can be based on the [[physical examination]], [[Complete blood count|complete red cell count]], [[Reticulocyte|reticulocyte count]], [[medical history]] and specific [[Test|tests]], preferentially, the EMA (eosin-5-maleimide binding) [[test]] and AGLT (acidified glycerol lysis time).
| author = [[Sayeeda Huq]], [[Mark A. C. Pietroni]], [[Hafizur Rahman]] & [[Mohammad Tariqul Alam]]
* The [[diagnosis]] can be made at any [[Ageing|age]], including the [[Neonatal|neonatal period]] from day of [[birth]].
| title = Hereditary spherocytosis
* The [[Diagnosis|diagnostic]] guidelines of [[hereditary spherocytosis]] from the British Committee for Standards in [[hematology]] do not recommend any additional [[Test|tests]] for [[Patient|patients]] with classical [[clinical]] features and [[Laboratory|laboratory data]].
| journal = [[Journal of health, population, and nutrition]]
* The eosin-5-maleimide (EMA) binding [[test]] has high [[Sensitivity (tests)|sensitivity]] (92–93%) and [[Specificity (tests)|specificity]] (99%) for [[hereditary spherocytosis]], although a positive [[test]] can also be obtained in [[Patient|patients]] affected by related [[Disease|conditions]], such as [[Congenital dyserythropoietic anemia|congenital dyserythropoietic anemia type II (CDA II)]]
| volume = 28
* Other [[Test|tests]], such as the osmotic fragility (OF) [[test]], acidified glycerol lysis test (AGLT) and the pink [[test]], exhibit lower [[Sensitivity (tests)|sensitivity]] compared to the EMA [[test]] (68%, 61% and 91%, respectively).
| issue = 1
* Ektacytometry is a highly [[Sensitivity (tests)|sensitive]] [[test]] of [[Cell membrane|membrane]] deformability.  
| pages = 107–109
| year = 2010
| month = February
| pmid = 20214092
}}</ref>
* The diagnosis can be made at any age, including the neonatal period from day of birth.<ref>{{Cite journal
| author = [[Yuki Tateno]], [[Ryoji Suzuki]] & [[Yukihiro Kitamura]]
| title = Previously undiagnosed hereditary spherocytosis in a patient with jaundice and pyelonephritis: a case report
| journal = [[Journal of medical case reports]]
| volume = 10
| issue = 1
| pages = 337
| year = 2016
| month = December
| doi = 10.1186/s13256-016-1144-8
| pmid = 27906107
}}</ref>
* The diagnostic guidelines of hereditary spherocytosis from the British Committee for Standards in hematology do not recommend any additional tests for patients with classical clinical features and laboratory data.
* The eosin-5-maleimide (EMA) binding test has high sensitivity (92–93%) and specificity (99%) for hereditary spherocytosis, although a positive test can also be obtained in patients affected by related conditions, such as congenital dyserythropoietic anemia type II (CDA II)
* Other tests, such as the osmotic fragility (OF) test, acidified glycerol lysis test (AGLT) and the pink test, exhibit lower sensitivity compared to the EMA test (68%, 61% and 91%, respectively).<ref>{{Cite journal
| author = [[Immacolata Andolfo]], [[Roberta Russo]], [[Antonella Gambale]] & [[Achille Iolascon]]
| title = New insights on hereditary erythrocyte membrane defects
| journal = [[Haematologica]]
| volume = 101
| issue = 11
| pages = 1284–1294
| year = 2016
| month = November
| doi = 10.3324/haematol.2016.142463
| pmid = 27756835
}}</ref>
* Ektacytometry is a highly sensitive test of membrane deformability.  
 
 


{| class="wikitable"
{| class="wikitable"
|+
|+
Simple Diagnostic Criteria to evoke the Diagnosis of Hereditary Spherocytosis
Simple [[Diagnosis|Diagnostic Criteria]] to evoke the [[Diagnosis]] of [[Hereditary spherocytosis|Hereditary Spherocytosis]]
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Clinical Parameters}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Clinical Parameters}}
| pallor, splenomegaly, inconstant jaundice
| [[pallor]], [[splenomegaly]], inconstant [[jaundice]]
|-
|-
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Biological paraneters & erythrocyte indices}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Biological paraneters & erythrocyte indices}}
| dec Hb, inc MCHC, inc %hyperdense cells, inc reticulocytes  
| [[Hemoglobin|dec Hb]], inc [[Mean corpuscular hemoglobin concentration|MCHC]], inc %hyperdense [[Cell (biology)|cells]], inc [[reticulocytes]]
|-
|-
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Blood smear}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Blood smear}}
| Spherocytes (may be absent)
| [[Spherocyte|Spherocytes]] (may be absent)
|-
|-
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Signs of hemolysis}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Signs of hemolysis}}
| inc free bilirubin, dec haptoglobin, inc reticulocytes
| inc free [[bilirubin]], dec [[haptoglobin]], inc [[reticulocytes]]
|-
|-
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Erythrocyte coombs test}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Erythrocyte coombs test}}
Line 65: Line 33:
{| class="wikitable"
{| class="wikitable"
|+
|+
Specific Biological Examinations for the Diagnosis of Hereditary Spherocytosis
Specific Biological Examinations for the [[Diagnosis]] of [[Hereditary spherocytosis|Hereditary Spherocytosis]]
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Tests}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Tests}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Principle/feasibility}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Principle/feasibility}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Sensitivity/Specificity}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Sensitivity/Specificity}}
|-
|-
| Osmotic resistance
| [[Osmosis|Osmotic resistance]]
| hemolysis test/routime examination
| [[hemolysis]] [[test]]/routime [[Physical examination|examination]]
| 66%/low
| 66%/low
|-
|-
| Pink test
| Pink [[test]]
| hemolysis test/simple test time-out test <3 hours
| [[hemolysis]] [[test]]/simple [[test]] time-out test <3 hours
| 96%/79-94%
| 96%/79-94%
|-
|-
| AGLT
| AGLT
| Hemolysis test time of test >3 hours
| [[Hemolysis]] [[test]] time of test >3 hours
| 81%/95%
| 81%/95%
|-
|-
| Ektacytometry in osmolar gradient
| Ektacytometry in osmolar gradient
| study of deformity of RBCs single laboratory in France test execution time:24 hours
| study of [[deformity]] of [[Red blood cell|RBCs]] single [[Medical laboratory|laboratory]] in France [[test]] execution time:24 hours
| reference exam
| reference exam
|-
|-
| Flow cytometry
| [[Flow cytometry]]
| labeling of RBCs with eosin 5 maleimide/not available on routine basis test run time >48 h
| labeling of [[Red blood cell|RBCs]] with eosin 5 maleimide/not available on routine basis [[test]] run time >48 h
| Being evaluated
| Being evaluated
|}
|}


 
* Newly [[Diagnosis|diagnosed]] [[Patient|patients]] with a [[family history]] of [[hereditary spherocytosis]], typical [[clinical]] features and [[Medical laboratory|laboratory]] investigations ([[Spherocyte|spherocytes]], raised [[Mean corpuscular hemoglobin concentration|mean corpuscular hemoglobin concentration (MCHC)]], increase in [[reticulocytes]]) do not require any additional [[Test|tests]].  
 
*  If the [[diagnosis]] is equivocal, a [[Screening (medicine)|screening test]] with high [[Predictive validity|predictive value]] for [[hereditary spherocytosis]] is helpful. The recommended [[Screening test|screening tests]] are the cryohaemolysis [[test]] and EMA binding.
* Newly diagnosed patients with a family history of HS, typical clinical features and laboratory investigations (spherocytes, raised mean corpuscular haemoglobin concentration [MCHC], increase in reticulocytes) do not require any additional tests.  
*  [[Gel electrophoresis]] analysis of [[Red blood cell|erythrocyte]] [[Cell membranes|membranes]] is the method of choice for [[diagnosis]] of atypical [[Disease|cases]].
*  If the diagnosis is equivocal, a screening test with high predictive value for HS is helpful. The recommended screening tests are the cryohaemolysis test and EMA binding.
*  Gel electrophoresis analysis of erythrocyte membranes is the method of choice for diagnosis of atypical cases.<ref>{{cite web |url=https://doi.org/10.1111/j.1365-2141.2011.08921.x+ |title=Guidelines for the diagnosis and management of hereditary spherocytosis – 2011 update - Bolton‐Maggs - 2012 - British Journal of Haematology - Wiley Online Library |format= |work= |accessdate=}}</ref>


==References==
==References==
<references />

Latest revision as of 07:20, 7 May 2020

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Overview

The diagnosis of hereditary spherocytosis can be based on physical examination, complete blood count (CBC), reticulocyte count, medical history and specific tests including eosin-5-maleimide binding (EMA) test and acidified glycerol lysis time (AGLT) test. The diagnosis can be made at any age. EMA binding test has high sensitivity and specificity for the hereditary spherocytosis. Other tests include; osmotic fragility (OF) test, pink test and ektacytometry. Gel electrophoresis analysis of erythrocyte membranes is the method of choice for diagnosis of atypical cases.

Diagnostic Criteria

Simple Diagnostic Criteria to evoke the Diagnosis of Hereditary Spherocytosis
Clinical Parameters pallor, splenomegaly, inconstant jaundice
Biological paraneters & erythrocyte indices dec Hb, inc MCHC, inc %hyperdense cells, inc reticulocytes
Blood smear Spherocytes (may be absent)
Signs of hemolysis inc free bilirubin, dec haptoglobin, inc reticulocytes
Erythrocyte coombs test negative
Specific Biological Examinations for the Diagnosis of Hereditary Spherocytosis
Tests Principle/feasibility Sensitivity/Specificity
Osmotic resistance hemolysis test/routime examination 66%/low
Pink test hemolysis test/simple test time-out test <3 hours 96%/79-94%
AGLT Hemolysis test time of test >3 hours 81%/95%
Ektacytometry in osmolar gradient study of deformity of RBCs single laboratory in France test execution time:24 hours reference exam
Flow cytometry labeling of RBCs with eosin 5 maleimide/not available on routine basis test run time >48 h Being evaluated

References