- Congenital spherocytic hemolytic anemia
- Congenital spherocytosis
- Spherocytic anemia
Your QuestionI have hereditary spherocytosis and I have a son that has it too. He had a splenectomy when he was almost 3 and he is 7 now. He is on penicillin every day. I have been told by his doctor (not a hematologist) that he doesn't have to be on the medicine anymore. Is that correct? Also, is there a chance my other unaffected kids can give this disorder to their kids?
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The American Academy of Pediatrics Committee on Infectious Diseases published a policy statement in 2000 which included the following information:
- Antibiotic prophylaxis is recommended for all children with sickle cell disease (SCD) and functional or anatomic asplenia, regardless of whether they have received pneumococcal immunizations.
- Although the efficacy of penicillin prophylaxis in children with functional or anatomic asplenia other than SCD has not been studied, it is reasonable to use prophylaxis in the same regimen.
- Antibiotic prophylaxis should be begun before 2 months of age or as soon as SCD or asplenia occurs or is otherwise recognized or suggested by screening procedures.
- Oral administration of penicillin V potassium is recommended at a dosage of 125 mg twice a day until 3 years of age and at a dosage of 250 mg twice a day after 3 years of age.
- Children who have not experienced invasive pneumococcal infection and have received recommended pneumococcal immunizations may discontinue penicillin prophylaxis after 5 years of age.
It has also been stated that individuals in whom prophylaxis is being discontinued should have well-established, regular medical care, and understand the warning symptoms and signs, as well as the management, of possible post-splenectomy sepsis. Individuals with highly compromised immune systems, and survivors of pneumococcal post-splenectomy sepsis, are reasonable candidates for prophylaxis until age 18, or even for life.
Individuals looking for specific medical advice for themselves or family members should speak with their health care provider.
Less commonly, hereditary spherocytosis is inherited in an autosomal recessive manner. This means that to be affected, a person must have a mutation in both copies of the responsible gene in each cell. Affected people inherit one mutated copy of the gene from each parent, who is referred to as a carrier. Carriers of an autosomal recessive condition typically do not have any signs or symptoms (they are unaffected). When 2 carriers of an autosomal recessive condition have children, each child has a:
- 25% (1 in 4) chance to be affected
- 50% (1 in 2) chance to be an unaffected carrier like each parent
- 25% chance to be unaffected and not be a carrier
The offspring of an individual with an autosomal recessive (AR) form of hereditary spherocytosis will definitely be a carrier of the condition. A carrier of an AR condition is generally only at risk to have an affected child if his/her partner is also a carrier for the condition, having a mutation in the same disease-causing gene. When 2 carriers of an AR condition have children, each child has a 25% (1 in 4) risk to be affected. If a carrier has a child with an individual who is not a carrier, that child will not be affected.
- Mark S Pasternack. Prevention of sepsis in the asplenic patient. UpToDate. Waltham, MA: UpToDate; 2012;
- American Academy of Pediatrics. Committee on Infectious Diseases. Policy statement: recommendations for the prevention of pneumococcal infections, including the use of pneumococcal conjugate vaccine (Prevnar), pneumococcal polysaccharide vaccine, and antibiotic prophylaxis. Pediatrics. August 2000; 106(2 Pt 1):362-366.
- Hereditary spherocytosis. Genetics Home Reference. September, 2013; http://ghr.nlm.nih.gov/condition/hereditary-spherocytosis.
- Hereditary spherocytosis. Genetics Home Reference. 2010; http://ghr.nlm.nih.gov/condition/hereditary-spherocytosis.