From the Guidelines
The presence of anisocytosis, microcytosis, poikilocytosis, and ovalocytes in the blood smear is most consistent with a diagnosis of iron deficiency anemia or thalassemia, and I recommend a complete blood count with iron studies to confirm the diagnosis. The blood smear shows several abnormalities in red blood cell (RBC) morphology, including moderate anisocytosis (2+) and microcytosis (2+), along with mild poikilocytosis (1+) and the presence of oval-shaped cells (ovalocytes 1+). Although the study by 1 discusses the diagnostic features of pyruvate kinase deficiency, which can also present with chronic hemolysis and abnormal RBC morphology, the specific pattern of abnormalities in this case is more suggestive of iron deficiency anemia or thalassemia.
- Key features of the blood smear include:
- Anisocytosis (variation in cell size)
- Microcytosis (small cells)
- Poikilocytosis (variation in cell shape)
- Ovalocytes (oval-shaped cells)
- To confirm the diagnosis, I recommend the following tests:
- Complete blood count (CBC)
- Iron studies, including serum iron, total iron binding capacity, and ferritin
- Hemoglobin electrophoresis to rule out thalassemia
- If iron deficiency is confirmed, treatment with oral iron supplementation, such as ferrous sulfate 325mg three times daily, would be appropriate, along with investigation of the underlying cause of iron deficiency, which could include gastrointestinal bleeding, poor dietary intake, or malabsorption, as discussed in the context of chronic hemolysis and abnormal RBC morphology by 1.
From the Research
RBC Morphology Abnormalities
- Anisocytosis 2+: indicates a variation in red blood cell size, which can be seen in various types of anemia, including iron deficiency anemia 2, 3
- Microcytosis 2+: suggests that the red blood cells are smaller than normal, which is a characteristic feature of microcytic anemia, such as iron deficiency anemia or thalassemia 2, 3, 4
- Poikolocytosis 1+: refers to the variation in red blood cell shape, which can be seen in various types of anemia, including iron deficiency anemia and hemolytic anemia 5, 4
- Ovalocytes 1+: indicates the presence of oval-shaped red blood cells, which can be seen in various types of anemia, including hereditary ovalocytosis and other red blood cell disorders 4
Diagnostic Considerations
- The presence of these RBC morphology abnormalities suggests that the patient may have an underlying anemia, such as iron deficiency anemia or other red blood cell disorders 2, 3, 6, 4
- Further laboratory tests, such as reticulocyte count, serum iron, and transferrin saturation, may be necessary to confirm the diagnosis and guide treatment 2, 3, 6
- The use of automated blood cell analyzers and RBC Advanced Application can aid in the detection and diagnosis of RBC morphology abnormalities 5