Department of Hematology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Kaohsiung J Med Sci. 2020 Jul;36(7):552-560. doi: 10.1002/kjm2.12198. Epub 2020 Mar 5.
Hereditary spherocytosis (HS) is often misdiagnosed due to lack of specific diagnostic methods. Our study summarized clinical characteristics and described the diagnostic workflow for mild and moderate HS in Chinese individuals, using data from 20 adults, 8 of whom presented a familial history for HS. We used scanning electron microscopy (SEM) to diagnose HS. We observed reduced eosin maleimide fluorescence activity (5.50 mean channel fluorescence (MCF) units) in the 10 cases of HS, which differed significantly when compared with 10 normal adults (15.50 units), iron deficiency anemia (15.50 MCF units), and megaloblastic anemia (12.00 MCF units) values (P < .05). Next generation sequencing results revealed that 9 out of 10 patients were found to have mutations in the spectrin alpha chain (SPTB), anchor protein (ANK1), and SLC4A1 genes. These mutations were not reported in the Human Gene Mutation Database (HGMD), 1000 human genome, ExAC, and dbSNP147 databases. Splenectomy proved to be beneficial in alleviating HS symptoms in 10 cases. It was found that for the diagnosis of HS, SEM and next generation gene sequencing method proved to be more ideal than red blood cell membrane protein analysis using sodium dodecyl sulfate polyacrylamide gel electrophoresis and western blotting.
遗传性球形红细胞增多症(HS)常因缺乏特异性诊断方法而误诊。本研究总结了临床特征,并描述了中国轻中度 HS 患者的诊断流程,共纳入 20 例成年人,其中 8 例有 HS 家族史。我们采用扫描电镜(SEM)诊断 HS。我们观察到 10 例 HS 患者的伊红马来酰亚胺荧光活性降低(平均荧光通道值 5.50),与 10 例正常成年人(15.50 单位)、缺铁性贫血(15.50 MCF 单位)和巨幼细胞性贫血(12.00 MCF 单位)相比差异有统计学意义(P < .05)。下一代测序结果显示,10 例患者中有 9 例存在血影蛋白α链(SPTB)、锚蛋白(ANK1)和 SLC4A1 基因突变。这些突变在人类基因突变数据库(HGMD)、1000 个人基因组、ExAC 和 dbSNP147 数据库中均未报道。脾切除术对 10 例患者缓解 HS 症状有效。研究发现,对于 HS 的诊断,SEM 和下一代基因测序方法比使用十二烷基硫酸钠聚丙烯酰胺凝胶电泳和 Western blot 分析红细胞膜蛋白更理想。