From the Research
Poikilocytosis and anisocytosis without anemia and with normal iron levels are generally considered benign findings that do not require immediate intervention. These morphological variations can occur as physiological adaptations or as early indicators of developing conditions that haven't yet affected hemoglobin levels. No specific treatment is needed for isolated poikilocytosis and anisocytosis when other parameters are normal, but monitoring with follow-up complete blood counts every 3-6 months is prudent to detect any progression 1. The clinical approach should focus on monitoring rather than immediate intervention, with further investigation warranted only if additional abnormalities develop or if these features persist or worsen over time. Key considerations in the evaluation of these findings include:
- The absence of anemia and normal iron studies, which suggests that erythropoiesis is currently adequate despite these morphological variations.
- The potential for these findings to reflect subtle changes in red blood cell production or membrane stability due to oxidative stress, mild liver dysfunction, medication effects, or early myelodysplastic changes.
- The possibility that these findings may appear as laboratory artifacts from sample handling or processing. Given the lack of strong evidence supporting a specific intervention for poikilocytosis and anisocytosis in the absence of anemia and with normal iron levels, a conservative approach focusing on monitoring is recommended, as supported by recent clinical guidelines 2, 1.