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It will readily cause fetal anemia and often hydrops fetalis. Prenatal diagnosis requires first ruling out immune and other non\u2010immune causes of fetal anemia. Diagnosis is made using characteristic blood smear morphology, ideally examined on a native blood sample, paired with exome sequencing. When these are inconclusive, laboratory tests such as ektacytometry and eosin\u20105\u2010maleimide flow cytometry can help distinguish HPP from other membranopathies. Prenatal disease almost always requires intrauterine transfusion. In the neonatal period, HPP will continue to cause severe anemia, and patients usually remain transfusion dependent until definitive intervention. For some patients, splenectomy relieves or reduces their transfusion requirements while others continue to be transfusion dependent. This response may be related to a patient's genotype. Allogeneic stem cell transplant (SCT) is an emerging therapy that has been performed in a few patients with good outcomes. We report three additional patients with membranopathy who have undergone SCT. All were diagnosed prenatally and required transfusion support pre\u2010 and post\u2010natally. Following SCT, all patients became transfusion independent and are doing well.<\/jats:p>","DOI":"10.1002\/pd.6867","type":"journal-article","created":{"date-parts":[[2025,7,26]],"date-time":"2025-07-26T15:29:54Z","timestamp":1753543794000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnosis and Management of Prenatal Hereditary Pyropoikilocytosis"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9770-8018","authenticated-orcid":false,"given":"Connor","family":"Hartzell","sequence":"first","affiliation":[{"name":"Division of Transfusion Medicine Department of Pathology, Microbiology, and Immunology Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samantha","family":"Stover","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine Department of Obstetrics &amp; Gynecology Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nora","family":"Gibson","sequence":"additional","affiliation":[{"name":"Divisions of Hematology and Oncology Department of Pediatrics Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy","family":"Olson","sequence":"additional","affiliation":[{"name":"Divisions of Hematology and Oncology Department of Pediatrics Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Connelly","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology Department of Pediatrics Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Grace","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine Department of Obstetrics &amp; Gynecology Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Andrews","sequence":"additional","affiliation":[{"name":"Division of Transfusion Medicine Department of Pathology, Microbiology, and Immunology Vanderbilt University Medical Center  Nashville Tennessee USA"},{"name":"Division of Hematology\/Oncology Department of Pediatrics Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,7,26]]},"reference":[{"key":"e_1_2_15_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102141.1975.tb02740.x"},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.v75.11.2235.bloodjournal75112235"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.274.4.2077"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.seminhematol.2004.01.003"},{"key":"e_1_2_15_6_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood\u20102010\u201001\u2010261396"},{"key":"e_1_2_15_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102141.2008.07091.x"},{"key":"e_1_2_15_8_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.bb.23.060194.004035"},{"key":"e_1_2_15_9_1","first-page":"650","volume-title":"Hematology: Basic Principles and Practice","author":"Gallagher P.","year":"2023"},{"key":"e_1_2_15_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijlh.12657"},{"key":"e_1_2_15_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/trf.17617"},{"key":"e_1_2_15_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.a.62489"},{"key":"e_1_2_15_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.crwh.2017.09.003"},{"key":"e_1_2_15_14_1","doi-asserted-by":"publisher","DOI":"10.1101\/mcs.a000885"},{"issue":"2","key":"e_1_2_15_15_1","first-page":"385","article-title":"Molecular Characteristics of Hereditary Red Blood Cell Membrane Disorders in Thailand: A Multi\u2010Center Registry [Published Correction Appears in Ann Hematol. 2024 Feb;103(2):395. 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