From the Research
Target cells in non-iron deficient patients are significant as they indicate other underlying pathologies that require investigation, such as hemoglobinopathies, liver disease, or post-splenectomy state, and warrant further diagnostic workup, including liver function tests, hemoglobin electrophoresis, medication review, and possibly genetic testing for hemoglobinopathies. Target cells (codocytes) appear as erythrocytes with a central concentration of hemoglobin surrounded by an area of pallor and a colored outer ring, giving them a "bull's-eye" appearance. While commonly associated with iron deficiency anemia, their presence in patients with normal iron studies suggests alternative conditions. The mechanism behind target cell formation in these conditions involves alterations in the red cell membrane composition or structure, leading to an increased surface area-to-volume ratio. According to the most recent study 1, hemoglobinopathies are the most common monogenic disorders in the world with an ever increasing global disease burden each year, and programs for preconception and antenatal carrier screening, with the option of prenatal diagnosis, are considered beneficial in many endemic countries.
Key Points to Consider
- The presence of target cells in non-iron deficient patients requires further investigation to rule out underlying pathologies such as hemoglobinopathies, liver disease, or post-splenectomy state.
- The percentage of target cells and their persistence over time can provide clues to the severity and chronicity of the underlying condition.
- Diagnostic workup should include liver function tests, hemoglobin electrophoresis, medication review, and possibly genetic testing for hemoglobinopathies, as suggested by 2 and 1.
- Hemoglobinopathies, such as thalassemia or sickle cell disease, can cause target cell formation, and their diagnosis and management are crucial to prevent complications, as discussed in 3, 4, and 5.
Management and Treatment
The management and treatment of target cell-related conditions depend on the underlying pathology. For example, patients with hemoglobinopathies may require blood transfusions, iron chelation, and other supportive treatments, as mentioned in 3 and 4. In contrast, patients with liver disease may require treatment of the underlying liver condition. A thorough diagnostic workup and consultation with a specialist are essential to determine the best course of treatment. As stated in 1, genotype-phenotype correlation and genetic testing can help identify rare rearrangements and novel factors influencing disease severity, leading to more effective management and treatment.