Macrothrombocytopenia/stomatocytosis specially associated with phytosterolemia.
Phytosterolemia is a rare autosomal recessive disease of plant sterol metabolism, the pathophysiological features of which are high plasma levels of plant sterols and xanthomatosis caused by mutations of ABCG5 and ABCG8 genes, and the combination of hemolysis and macrothrombocytopenia is an unusual clinical manifestation. All the patients of the 3 unrelated phytosterolemia first presented with prominent macrothrombocytopenia and stomatocytosis. They were either homozygous or compound heterozygous for ABCG5/ABCG8 gene mutations and had significantly elevated serum plant sterols levels quantified using high-performance liquid chromatography. The in vitro study demonstrated that sitosterol can cause changes in shape and osmotic fragility of red blood cells. These findings suggest that macrothrombocytopenia and stomatocytosis could be initial and main features in some patients with phytosterolemia and that serum phytosterols and relevant genes should be analyzed in patients whose macrothrombocytopenia and/or stomatocytosis are unexplained, especially whose parents are of consanguineous marriage.
Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.
Gaifeng
G
Wang
Lijuan
L
Cao
Zhaoyue
Z
Wang
Minghua
M
Jiang
Xionghua
X
Sun
Xia
X
Bai
Changgeng
C
Ruan
D000071018:ATP Binding Cassette Transporter, Subfamily G, Member 5; D000071019:ATP Binding Cassette Transporter, Subfamily G, Member 8; D018528:ATP-Binding Cassette Transporters / Q000235:genetics* / Q000378:metabolism; D004913:Erythrocytes, Abnormal / Q000378:metabolism / Q000473:pathology; D005260:Female; D006579:Heterozygote; D006720:Homozygote; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000235:genetics* / Q000473:pathology; D007410:Intestinal Diseases / Q000097:blood / Q000235:genetics* / Q000473:pathology; D008052:Lipid Metabolism, Inborn Errors / Q000097:blood / Q000235:genetics* / Q000473:pathology; D008074:Lipoproteins / Q000235:genetics* / Q000378:metabolism; D008297:Male; D009154:Mutation; D009996:Osmotic Fragility / Q000235:genetics; D010375:Pedigree; D010840:Phytosterols / Q000009:adverse effects / Q000097:blood / Q000235:genetics; D012855:Sitosterols / Q000097:blood; D014973:Xanthomatosis / Q000097:blood / Q000235:genetics* / Q000473:pathology
C416945:ABCG5 protein, human; C416946:ABCG8 protein, human; D000071018:ATP Binding Cassette Transporter, Subfamily G, Member 5; D000071019:ATP Binding Cassette Transporter, Subfamily G, Member 8; D018528:ATP-Binding Cassette Transporters; D008074:Lipoproteins; D010840:Phytosterols; D012855:Sitosterols; C025473:gamma-sitosterol