Poikilocytosis

Definition of poikilocytosis

Poikilocytosis is a blood disorder in which 10% or more red blood cells (RBCs) are abnormally shaped. These abnormal shaped RBCs are termed as poikilocytes. Poikilocytes are of different types depending upon their cellular structures that are specifically associated with different disease conditions. Their classification is mentioned in the below table:

Name of the PoikilocytesRelated Disease Condition
Teardrop cell – RBCs look like teardropsMyelofibrosis with myeloid metaplasia
Target cell – RBCs look like bull’s eye as haemoglobin placed in centre of cell.Hemoglobinopathies, thalassemia, Splenectomy, anaemia and liver cirrhosis.
Spherocyte – Rounded smaller RBCsGenetic spherocytosis, severe burns, anaemia
Sickle cell – Haemoglobins are ‘S’ shaped with Thorn shaped RBCsSickle cell anemia
Schistocyte – Red Blodd Cells become fragmented with no proper shape and sizePlatelets disorder like Thrombocytosis, purpura, coagulation disorder, Hemolytic uremic syndrome, Severe Burn
Acanthocyte –  RBCs arranged irregularlyMicroangiopathic hemolytic anemia, Severe liver disorder, Abetalipoproteinemia
Stomatocyte- Cup shaped 3-dimentional RBCsHepatic disorder, Hereditary stomatocytosis, Rhnullphenotype
Ovalocyte –  RBCs are pencil-shapedHereditary elliptocytosis, Anaemia, Certain thalassemias
Bite cell – the shaped of RBCs are like bite taken out from them.Poisoning, liver cirrhosis due to alcohol consumption, Hemolytic anemia.
Echinocyte – Usuualy smaller with rounded projection at the outer edge of the RBCsUremia, sever stomach diseases like cancer, ulceration.

Classification of Poikilocytes

Image 1: Classification of Poikilocytosis


Causes of Poikilocytosis

Possibilities of development of Poikilocytosis are:

Nutritional Deficiency

For development of red blood cells, the essential requirements are vitamin B12 and folic acid. Vitamin B12 is necessary for absorption of nutrients into small intestine. Deficiency of vitamin B12 leads to malabsorption of folic acid and other essential minerals such as iron.

The deficiency of folic acid leads to immature RBCs and deficiency of haemoglobin as folic acid plays an important role in maturation of RBCs and Haemoglobin formation. Iron deficiency also hampers the structural development of the haemoglobin. Nutritional deficiency of vitamin B12 and folic acid causes anaemia and sometimes deform the RBCs structure.

Associated Diseases

The associated disease conditions like celiac disease, regional enteritis and tropical sprue which are mainly occur in small intestine and lead to impaired absorption of dietary nutrients specifically folic acids and causes deformed RBCs due to immaturity. Leukaemia is also leads to poikilocytosis.


Symptoms of Poikilocytosis

Normal RBCs perform some vital biological activities. The main functions of RBCs are transportation of oxygen and nutrients to every part of the living tissue which is necessary for normal functioning and overall growth of the body.

Poikilocytes, Poikilocytosis

Image 2: Poikilocytosis

In poikilocytosis, normal functioning of RBCs are hampered due to their deformity which leads to:

  • Anaemia
  • Weight loss
  • Growth retardation
  • Heart Diseases

Apart from these general symptoms, depending upon the types of deformity and associated disease condition provides specific symptoms.

Treatment of Poikilocytosis

Before initiating the treatment for poikilocytosis, it is important to know about the cause of the disorder progression. For this different blood tests are conducted. The included tests are:

Differential Blood count

In this test the number of different blood cells is counted and the abnormality may lead to further diagnosis.

Blood Film Test

In this test the blood is spread on a slide and prepares a thin film smear and that slide is examined under microscope to determine the shape of each cell. This test helps to identify the structural deformity of the RBCs.

Blood composition test

In this test the amount of different essential enzymes, nutrients are checked to determine the deficiency of them.

Haemoglobin Test

As anaemia is a prime symptom of poikilocytosis, haemoglobin percentage analysis is important.

Other than these general blood tests, doctors may recommend other diagnosis according to the medical requirement depending upon the findings.

After diagnosing the specific reason of poikilocytosis, the effective treatment will be initiated. If the nutrients deficiency is the major reason then proper diet chart which contains sufficient Folic acid and vitamin B12 is recommended.

Natural source of Folic Acid and Vitamin B12

Meat, egg yolk, soya products, lentils, almond, whole grains, spinach, beet root, broccoli, cabbage etc.

Dietary supplements

The rich sources of folic acid and vitamin B12 are non vegetarian items, so if deficiency occurs in vegetarians then different dietary supplements are present which can adequately supply folic acid and vitamin B12.

Gluten free diet

In case of celiac disease which leads to poikilocytosis, gluten free diet is essential to control the disease. Other medical procedure may be implemented by the doctor to improve the celiac disease condition.

Chemotherapy

If cancer leads to poikilocytosis, then appropriate cancer chemotherapy helps to control poikilocytosis.


References

  1. http://poikilocytosis.net/blood-test-and-poikilocytosis/
  2. http://www.rightdiagnosis.com/h/hereditary_pyropoikilocytosis/symptoms.htm
  3. https://www.medialabinc.net/spg470574/poikilocytosis_review_table.aspx
  4. http://medicaltreasure.com/poikilocytosis/

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