ZRSR2 mutation in a child with refractory macrocytic anemia and Down Syndrome

Pediatr Hematol Oncol. 2019 May;36(4):236-243. doi: 10.1080/08880018.2019.1621969. Epub 2019 Jul 30.


Here we report a case of refractory macrocytic anemia with a spliceosomal point mutation involving the ZRSR2 gene in a child with Down syndrome (DS). Such mutations have been shown to cause refractory macrocytic anemia and myelodysplastic syndrome (MDS) in elderly individuals. We report the hematological indices of a child with DS and a ZRSR2 spliceosomal mutation. DS is known to produce macrocytic anemia but does not lead to transfusion dependence. In this case, the ZRSR2 mutation was the likely implicating factor for severe transfusion-dependent anemia in a child with DS. The clinical implication of a ZRSR2 mutation in a child with DS has not been previously described and warrants close surveillance to detect potential insidious transformation to MDS.

Keywords: Down syndrome; myelodysplastic syndrome; refractory macrocytic anemia; spliceosomal mutation.

Publication types

  • Case Reports

MeSH terms

  • Anemia, Macrocytic / blood
  • Anemia, Macrocytic / genetics*
  • Anemia, Macrocytic / therapy
  • Child
  • Down Syndrome / blood
  • Down Syndrome / genetics*
  • Down Syndrome / therapy
  • Humans
  • Male
  • Point Mutation*
  • Ribonucleoproteins / genetics*
  • Ribonucleoproteins / metabolism


  • Ribonucleoproteins
  • ZRSR2 protein, human