title: Evaluating eosin-5-maleimide binding as a diagnostic test for hereditary spherocytosis in newborn infants.
abstract: OBJECTIVE
  Neonates with undiagnosed hereditary spherocytosis (HS) are at risk for developing hazardous hyperbilirubinemia and anemia. Making an early diagnosis of HS in a neonate can prompt anticipatory guidance to prevent these adverse outcomes. A recent comparison study showed that a relatively new diagnostic test for HS, eosin-5-maleimide (EMA)-flow cytometry, performs better than other available tests in confirming HS. However, reports have not specifically examined the performance of this test among neonates.
  
  
  METHODS
  We compared EMA-flow cytometry from blood samples of healthy control neonates vs samples from neonates suspected of having HS on the basis of severe Coombs-negative jaundice and spherocytes on blood film. The diagnosis of HS was later either confirmed or excluded based on clinical findings and next generation sequencing (NGS) after which we correlated the EMA-flow results with the diagnosis.
  
  
  RESULTS
  EMA-flow was performed on the blood of 31 neonates; 20 healthy term newborns and 11 who were suspected of having HS. Eight of the 11 were later confirmed positive for HS and one was confirmed positive for hereditary elliptocytosis (HE). All nine had persistently abnormal erythroid morphology, reticulocytosis and anemia, and eight of the nine had relevant mutations discovered using NGS. The other was confirmed positive for HS on the basis that a parent had HS, and the neonate's spherocytosis, reticulocytosis and anemia persisted. The 20 healthy controls and the 2 in whom HS was initially suspected but later excluded all had EMA-flow results in the range reported in healthy children and adults. In contrast, all nine in whom HS or HE was confirmed had abnormal EMA-flow results consistent with previous reports in older children and adults with HS.
  
  
  CONCLUSIONS
  Although our sample size is small, our findings are consistent with the literature in older children and adults suggesting that EMA-flow cytometric testing performs well in supporting the diagnosis of HS/HE during the early neonatal period.
authors.affiliation: 1] The Department of Women and Newborns, Intermountain Healthcare, Salt Lake City, UT, USA [2] Division of Neonatology, University of Utah School of Medicine, Salt Lake City, UT, USA [3] Division of Hematology/Oncology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: R D
authors.initials: RD
authors.lastname: Christensen
authors.affiliation: 1] Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA [2] ARUP Laboratories, Salt Lake City, UT, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Agarwal
authors.affiliation: Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: R H
authors.initials: RH
authors.lastname: Nussenzveig
authors.affiliation: 1] Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA [2] ARUP Laboratories, Salt Lake City, UT, USA.
authors.forename: N
authors.initials: N
authors.lastname: Heikal
authors.affiliation: Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Liew
authors.affiliation: Division of Hematology/Oncology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: H M
authors.initials: HM
authors.lastname: Yaish
mesh_terms: D016022:Case-Control Studies; D004801:Eosine Yellowish-(YS) / Q000031:analogs & derivatives* / Q000032:analysis; D005434:Flow Cytometry; D059014:High-Throughput Nucleotide Sequencing; D006801:Humans; D007231:Infant, Newborn; D015997:Neonatal Screening; D013102:Spherocytes; D013103:Spherocytosis, Hereditary / Q000175:diagnosis* / Q000235:genetics*
chemical_list: C033531:eosin maleimide; D004801:Eosine Yellowish-(YS)