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Blood, 15 August 2000, Vol. 96, No. 4, pp. 1602-1604

BRIEF REPORT

Severe hereditary spherocytosis and distal renal tubular acidosis associated with the total absence of band 3

Maria Letícia Ribeiro, Nicole Alloisio, Helena Almeida, Clara Gomes, Pascale Texier, Carlos Lemos, Gabriela Mimoso, Laurette Morlé, Faïza Bey-Cabet, René-Charles Rudigoz, Jean Delaunay, and Gabriel Tamagnini

From Unidade de Hematologia Molecular, Serviço de Hematologia, Centro Hospitalar de Coimbra, Coimbra, Portugal; Laboratoire de Génétique Humaine, CNRS URA 1171, and Centre de Génétique Moléculaire et Cellulaire, CNRS UMR 5534, Villeurbanne, France; Unidade de Nefrologia, Hospital Pediátrico de Coimbra, Coimbra, Portugal; Maternidade Bissaya Barreto, Centro Hospitalar de Coimbra, Coimbra, Portugal; Service de Biochimie, Hôpital Debrousse, Lyon, France; Service d'Obstétrique, Hôpital de la Croix-Rousse, Lyon, France.

Absence of band 3, associated with the mutation Coimbra (V488M) in the homozygous state, caused severe hereditary spherocytosis in a young child. Although prenatal testing was made available to the parents, it was declined. Because the fetus stopped moving near term, an emergency cesarean section was performed and a severely anemic, hydropic female baby was delivered. She was resuscitated and initially kept alive with respiratory assistance and hypertransfusion therapy. Cord blood smears revealed erythroblastosis, poikilocytosis, and red cells with stalk-like elongations. Band 3 and protein 4.2 were absent; spectrin, ankyrin, and glycophorin A were significantly reduced. Renal tubular acidosis was detected by the age of 3 months. Nephrocalcinosis appeared soon thereafter. After 3 years of follow-up the child is doing reasonably well on a regimen that includes regular blood transfusions and daily bicarbonate supplements. The long-term prognosis remains uncertain given the potential for hematologic and renal complications.

© 2000 by The American Society of Hematology.
 

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