From the Guidelines
The presence of target cells on a complete blood count (CBC) necessitates a thorough investigation into the underlying cause, as these cells are indicative of various conditions that may impact morbidity, mortality, and quality of life. When managing a patient with target cells on their CBC, it is crucial to consider the potential underlying conditions that could be contributing to this finding, such as hemoglobinopathies, liver disease, post-splenectomy state, or nutritional deficiencies 1. The initial step in the management plan should involve a comprehensive history and physical examination, followed by targeted laboratory tests to identify the cause. Some key tests to consider include:
- Hemoglobin electrophoresis to diagnose hemoglobinopathies
- Liver function tests to assess for liver disease
- Iron studies to evaluate for iron deficiency
- Evaluation for splenomegaly, which could indicate a post-splenectomy state or other conditions affecting the spleen Treatment should then be directed at the underlying condition rather than the target cells themselves. For instance, if the target cells are associated with a hemoglobinopathy like sickle cell disease, management might include hydroxyurea, while liver disease management would depend on the etiology but could involve addressing alcohol use, treating viral hepatitis, or managing autoimmune conditions. Given the potential for significant morbidity and mortality associated with the conditions that cause target cells, it is essential to prioritize a thorough diagnostic workup and tailored treatment plan to improve patient outcomes and quality of life. In the context of real-life clinical medicine, where evidence may not always be definitive, a cautious approach that prioritizes comprehensive evaluation and management based on the most likely underlying cause is prudent, considering the potential impact on patient morbidity, mortality, and quality of life 1.
From the Research
Target Cells
- Target cells are a type of abnormal red blood cell that appears in certain diseases, including sickle cell disease and other hemoglobinopathies 2.
- These cells have a distinctive shape, with a thin center and a thick outer rim, giving them a "target" appearance.
- Target cells are formed due to a band 3-based mechanism of erythrocyte shape control, which is affected by the inheritance of certain hemoglobin variants, such as Hb S 2.
Management Plan
- The management plan for a patient with target cells on their complete blood count (CBC) depends on the underlying cause of the target cells.
- For patients with sickle cell disease, management may include supportive care, such as pain management and hydration, as well as disease-modifying therapies, such as hydroxyurea 3.
- For patients with other hemoglobinopathies, management may include blood transfusions, iron chelation, and other supportive therapies 3.
- Gene therapy is also being explored as a potential treatment for certain hemoglobinopathies, including beta-thalassemia and sickle cell disease 4.
Follow-up
- Patients with target cells on their CBC should be followed up regularly to monitor their condition and adjust their management plan as needed.
- Follow-up may include regular CBCs, as well as other tests, such as hemoglobin electrophoresis, to monitor the patient's hemoglobinopathy 3.
- Patients should also be educated on how to manage their condition and prevent complications, such as pain crises and infections 3.