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Stomatocytosis and anemia developing in hypophosphatemia: causes, symptoms, diagnosis, treatment
Last reviewed: 07.07.2025
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[ Stomatocytosis
Stomatocytosis is a rare red blood cell condition in which the central zone of the red blood cell has a "mouth" or "slit" shape. These cells are associated with congenital or acquired hemolytic anemia. The symptoms of the disease are due to the anemia.
Rarely occurring hereditary stomatocytosis has an autosomal dominant pattern of inheritance and manifests itself in early life. The red blood cell membrane has increased permeability to monovalent cations (Na and K), while it remains normal for divalent cations and anions. About 20-30% of circulating red blood cells are stomatocytes. Red blood cell fragility is increased, as is the autohemolysis test with inconsistent glucose correction. In some cases, splenectomy improves the severity of anemia.
Acquired stomatocytosis with hemolytic anemia occurs mainly with alcohol intake in large doses. Stomatocytosis in the blood and hemolysis disappear within 2 weeks after stopping alcohol consumption.
Anemia due to hypophosphatemia
Red blood cell plasticity varies with intracellular ATP levels. Because serum phosphate concentrations influence red blood cell ATP levels, red blood cell ATP levels decrease at serum phosphate concentrations less than 0.5 mg/dL (< 0.16 mmol/L). The metabolic consequences of hypophosphatemia also include depletion of 2,3-diphosphoglyceric acid, a leftward shift in the 0 2 dissociation curve, decreased glucose utilization, and increased lactate production. As a result, rigid, inelastic red blood cells become susceptible to damage in the capillary bed, leading to hemolysis, small size, and spherical shape of red blood cells (microspherocytosis).
Marked hypophosphatemia may occur with abrupt cessation of alcohol intake, diabetes mellitus, overfeeding after prolonged fasting, the recovery (diuretic) phase after severe burns, overnutrition, marked respiratory alkalosis, and in uremic patients undergoing dialysis and taking antacids. Phosphate supplementation prevents or reverses the anemia and identifies a patient population with or at risk of hypophosphatemia.