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Living with Autoimmune lymphoproliferative syndrome type 4

A rare genetic condition with extra immune cells, low blood cell counts from autoimmunity, and an enlarged liver and spleen.

Understanding Autoimmune lymphoproliferative syndrome type 4

Autoimmune lymphoproliferative syndrome type 4, also called RAS-associated autoimmune leukoproliferative disease (RALD), is a rare genetic immune disorder.

Features include a high number of certain white blood cells (monocytosis), low blood counts from autoimmunity, growth of immune tissue (lymphoproliferation), an enlarged liver and spleen, and high levels of antibodies. It starts in infancy or childhood.

Signs & symptoms

GARD lists these among the less common symptoms:

  • Repeated infections
  • Repeated respiratory infections
  • Low platelets from autoimmunity (thrombocytopenia)
  • Autoimmune conditions

Not everyone has every symptom. GARD's list comes from the Human Phenotype Ontology.

Diagnosis

  1. Talk with your doctor

    Share the symptoms you've noticed, when they started and your family health history. Notes and photos can help.

  2. See a specialist

    Specialists who may be involved include allergy and immune system specialists, blood and bone marrow specialists, cancer specialists and genetic specialists.

  3. Ask which tests can help

    Your care team will decide which exams and tests can confirm the diagnosis.

  4. Connect with expert centers

    Immune Deficiency Foundation may keep lists of experts for this condition.

Care & treatment

Care team
Allergy and immune system specialists (allergists / immunologists); Blood and bone marrow specialists (hematologists); Cancer specialists (oncologists); Genetic specialists (geneticists)
Expert care
Expert lists: Immune Deficiency Foundation
Treatment
GARD doesn't list specific treatments for this condition. Your care team will tailor care to your symptoms.
Research
Clinical trials and observational studies may be options. See the research section below.

General information, not medical advice. Your care team makes the decisions.

Everyday life

Living with a rare condition is easier with support.

  • Connect with Immune Deficiency Foundation
  • Keep notes on symptoms, changes and questions for appointments
  • Ask about patient registries that help research
  • Look into financial aid and travel resources for care visits
Bring these questions to your next doctor visit
Which blood tests help confirm RALD?
How are my blood counts monitored?
Would genetic testing help my relatives?

Quick facts

Symptoms usually startInfant and as a Child
InheritanceAutosomal Dominant

GARD says changes in genes (also called variants) cause this condition. It is autosomal dominant, meaning one changed copy of the gene can be enough to cause it.

GeneticBlood

Also known as: alps type 4; alps type iv; alps4; autoimmune lymphoproliferative syndrome caused by mutation in nras; autoimmune lymphoproliferative syndrome type iv; autoimmune lymphoproliferative syndrome, type iv

Patient organizations

Broader rare-disease groups

Source: NIH GARD · Autoimmune lymphoproliferative syndrome type 4GARD ID 17262 · GARD page updated September 2026 · Plain-language summary by Know Rare; editorial review pending. General information, not medical advice.

You are more than your diagnosis

Perspectives from people navigating life with Autoimmune lymphoproliferative syndrome type 4.

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