Hereditary spherocytic anemia
Congenital spherocytic hemolytic anemia; Spherocytosis; Hemolytic anemia - spherocyticHereditary spherocytic anemia is a rare disorder of the surface layer (membrane) of red blood cells. It leads to red blood cells that are shaped like spheres, and premature breakdown of red blood cells (hemolytic anemia).
Hemolytic anemia
Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. Normally, red ...

Causes
This disorder is caused by a defective gene. The defect results in an abnormal red blood cell membrane. The affected cells have a smaller surface area for their volume than normal red blood cells, and can break open easily.
The anemia can vary from mild to severe. In severe cases the disorder may be found in early childhood. In mild cases it may go unnoticed until adulthood.
Anemia
Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. Different type...

This disorder is most common in people of northern European descent, but it has been found in all races.
Symptoms
Infants may have yellowing of the skin and eyes (jaundice) and pale coloring (pallor).
Jaundice
Jaundice is a yellow color of the skin, mucus membranes, or eyes. The yellow coloring comes from bilirubin, a byproduct of old red blood cells. Jau...

Pallor
Paleness is an abnormal loss of color from normal skin or mucous membranes.
Read Article Now Book Mark ArticleOther symptoms may include:
- Fatigue
Fatigue
Fatigue is a feeling of weariness, tiredness, or lack of energy.
Read Article Now Book Mark Article - Irritability
- Shortness of breath
Shortness of breath
Breathing difficulty may involve:Difficult breathing Uncomfortable breathingFeeling like you are not getting enough air
ImageRead Article Now Book Mark Article - Weakness
Exams and Tests
In most cases, the spleen is enlarged.
Laboratory tests can help diagnose this condition. Tests may include:
- Blood smear to show abnormally shaped cells
- Bilirubin level
Bilirubin level
The bilirubin blood test measures the level of bilirubin in the blood. Bilirubin is a yellowish pigment found in bile, a fluid made by the liver. Bi...
ImageRead Article Now Book Mark Article - Complete blood count to check for anemia
Complete blood count
A complete blood count (CBC) test measures the following:The number of white blood cells (WBC count)The number of red blood cells (RBC count)The numb...
ImageRead Article Now Book Mark Article - Coombs test
Coombs test
The Coombs test looks for antibodies that may stick to your red blood cells and cause red blood cells to die too early.
Read Article Now Book Mark Article - LDH level
- Haptoglobin level
- Osmotic fragility or specialized testing to evaluate for the red blood cell defect
Osmotic fragility
Osmotic fragility is a blood test to detect whether red blood cells are more likely to break down.
Read Article Now Book Mark Article - Reticulocyte count
Reticulocyte count
Reticulocytes are slightly immature red blood cells. A reticulocyte count is a blood test that measures the amount of these cells in the blood....
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Treatment
Surgery to remove the spleen (splenectomy) cures the anemia but does not correct the abnormal cell shape.
Splenectomy
Spleen removal is surgery to remove a diseased or damaged spleen. This surgery is called splenectomy. The spleen is in the upper part of the belly, ...

Families with a history of spherocytosis should have their children screened for this disorder.
Children should wait until age 5 to have splenectomy because of the infection risk. In mild cases discovered in adults, it may not be necessary to remove the spleen.
Children and adults should be given a pneumococcal vaccine before spleen removal surgery. They also should receive folic acid supplements. Additional vaccines may be needed based on the person's history.
Support Groups
More information and support for people with hereditary spherocytic anemia and their families can be found at:
- Genetic and Rare Diseases Information Center -- rarediseases.info.nih.gov/diseases/6639/hereditary-spherocytosis
- National Organization for Rare Disorders -- rarediseases.org/rare-diseases/anemia-hereditary-spherocytic-hemolytic
Outlook (Prognosis)
The outcome is usually good with treatment. After the spleen is removed, the life span of the red blood cell returns to normal.
Possible Complications
Complications may include:
- Gallstones
Gallstones
Gallstones are hard deposits that form inside the gallbladder. These may be as small as a grain of sand or as large as a golf ball.
ImageRead Article Now Book Mark Article - Much lower red blood cell production (aplastic crisis) caused by a viral infection, which can make anemia worse
When to Contact a Medical Professional
Contact your health care provider if:
- Your symptoms get worse.
- Your symptoms do not improve with new treatment.
- You develop new symptoms.
Prevention
This is an inherited disorder and may not be preventable. Being aware of your risk, such as a family history of the disorder, may help you get diagnosed and treated early.
References
Gallagher PG. Red blood cell membrane disorders. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 45.
Merguerian MD, Gallagher PG. Hereditary spherocytosis. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 485.
Red blood cells - normal - illustration
This photomicrograph shows normal red blood cells (RBCs) as seen in the microscope after staining.
Red blood cells - normal
illustration
Red blood cells - spherocytosis - illustration
Spherocytosis is a hereditary disorder of the red blood cells (RBCs), which may be associated with a mild anemia. Typically, the affected RBCs are small, spherically shaped, and lack the light centers seen in normal, round RBCs.
Red blood cells - spherocytosis
illustration
Blood cells - illustration
Blood is comprised of red blood cells, platelets, and various white blood cells.
Blood cells
illustration
Red blood cells - normal - illustration
This photomicrograph shows normal red blood cells (RBCs) as seen in the microscope after staining.
Red blood cells - normal
illustration
Red blood cells - spherocytosis - illustration
Spherocytosis is a hereditary disorder of the red blood cells (RBCs), which may be associated with a mild anemia. Typically, the affected RBCs are small, spherically shaped, and lack the light centers seen in normal, round RBCs.
Red blood cells - spherocytosis
illustration
Blood cells - illustration
Blood is comprised of red blood cells, platelets, and various white blood cells.
Blood cells
illustration
Review Date: 1/25/2022
Reviewed By: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.