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A Case of Hereditary Spherocytosis Misdiagnosed as Pyruvate Kinase Deficient Hemolytic Anemia by Cristina Vercellati, Anna Paola Marcello, Elisa Fermo, Wilma Barcellini, Alberto Zanella, Paola Bianchi

Background: Hereditary spherocytosis (HS) and pyruvate kinase (PK) deficiency are the most common causes of congenital hemolytic anemia. We describe a case of HS with defective PK activity initially misdiagnosed as PK deficiency.
Methods: Hematologic investigation, SDS-PAGE analysis of red cell membrane proteins and sequencing of the PKLR gene were performed.
Results: The molecular characterization of the PKLR gene showed a heterozygous mutation 994G > A (Gly332Ser) associated with the promoter substitution -148C > T, whose role in the pathophysiology of PK deficiency is debated. Further investigations revealed spectrin deficiency; the family study demonstrated that the hemolysis was
exclusively attributable to HS.
Conclusions: The present case pinpoints to the need for extensive family investigations to correctly diagnose chronic hemolytic anemia, in particular when molecular characterization does not fully explain the clinical phenotype.

DOI: 10.7754/Clin.Lab.2012.120905