APIH243885244 - CME/CMLE - Blood Cell ID #3: Peripheral Blood Cells in a Patient with Iron Deficiency Anemia-APIH243885244

APIH243885244 - Educational Activity

Pdf Summary

This educational commentary by Karen A. Brown, MS, MASCP, MLS (ASCP)CM, discusses peripheral blood cell morphology in a 29-year-old female patient presenting with extreme fatigue and ultimately diagnosed with iron deficiency anemia (IDA). The patient's CBC showed anemia with low RBC count, hemoglobin, and hematocrit, along with a high red cell distribution width (RDW) and elevated platelet count. <br /><br />Key blood cells identified on the peripheral smear include:<br /><br />1. Polychromatophilic erythrocytes (reticulocytes): Immature red blood cells that appear blue-gray on Wright stain due to residual RNA. They are usually slightly larger than mature RBCs and lack central pallor. Polychromasia typically indicates increased marrow activity and early release of reticulocytes but is uncommon in IDA because erythropoiesis is often ineffective.<br /><br />2. Monocytes: The largest normal white cells, round or irregular with abundant blue-gray cytoplasm containing vacuoles but no prominent azurophilic granules. Their nuclei vary in shape and chromatin is lightly clumped.<br /><br />3. Eosinophils: Medium-sized granulocytes with large, uniform red-orange cytoplasmic granules and bilobed nuclei with dense chromatin.<br /><br />4. Band neutrophils: Immature neutrophils with a distinctive curved or band-shaped nucleus connected by thick chromatin strands and smaller violet-pink granules. Present in small numbers normally.<br /><br />5. Segmented neutrophils: Mature neutrophils with 2-5 nuclear lobes connected by thin chromatin strands and violet-pink granules.<br /><br />IDA develops from iron depletion leading to ineffective erythropoiesis and anemia. Morphologic RBC changes include microcytosis, hypochromia, anisocytosis, poikilocytosis, and characteristic ovalocytes (“pencil cells”) caused by membrane alterations from iron deficiency. There are generally no significant leukocyte abnormalities in IDA.<br /><br />The commentary emphasizes the importance of detailed morphologic review of peripheral blood cells to aid accurate diagnosis. The presence of polychromasia is atypical in IDA, reflecting variable marrow response. Confirmatory IDA testing includes iron studies such as serum iron, transferrin saturation, and total iron binding capacity.<br /><br />In summary, this case highlights typical and atypical peripheral blood cell morphologies in IDA, underscoring careful microscopic evaluation for proper diagnosis and patient care.

Keywords

iron deficiency anemia

peripheral blood smear

polychromatophilic erythrocytes

reticulocytes

monocytes

eosinophils

band neutrophils

segmented neutrophils

microcytosis

anisocytosis