On the evaluation of the peripheral blood smear, 20% of the patients showed moderate degree of anisocytosis and poikilocytosis
, which was mainly found in P.
The blood picture revealed hypochromasia, poikilocytosis
A radiograph of the feet and ankles revealed no abnormalities but a FBC with a smear revealed a hypochromic, microcytic anaemia (Hb 8.2 g/dL) with teardrop cells, scanty pencil cells, target cells and mild poikilocytosis
. This prompted investigation with Hb electrophoresis that showed significantly elevated levels of HbF (19.1%) and HbS (77.9%) with decreased levels of HbA2 (0%) and an HbA of 3%.
On differential count, there is significant rise in absolute neutrophil count (P < 0.005), significant fall in absolute lymphocyte count (P < 0.005), and rise in eosinophil and basophil count which is not statistically significant, not much difference in monocyte count in both groups, associated poikilocytosis
and anisocytosis of red blood cells in anemic subjects, and N/L ratio is significantly higher in the anemics (P < 0.001).
Laboratory testing was significant for white blood cell count of 53.3 G/L, and differential included 88% neutrophils, 4.5% lymphocytes, 3.3 G/L monocytes, 0.15 G/L basophils, 3+ poikilocytosis
, 2+ polychromasia, 1+ Howell-Jolly bodies, and 1+ vacuolated polymorphonuclear lymphocytes with target and sickle cells present.
A peripheral smear revealed poikilocytosis
, macrocytosis, anisocytosis, and ovalocytes.
(Figures 1, 2) Also on day-2, erythrocytes began to show poikilocytosis
with crenated forms and cytoplasmic spikes (burr cells, echinocytes).
Hypochromic microcytic red cell in proportion to degree of anaemia, with poikilocytosis
anisocytosis, pencil cells, red cell count less than 5 million/mm3 and MCV less than 75fl usually favors iron deficiency.
Hematological alterations were found to be accompanied by poikilocytosis
Both the hemoglobin and hematocrit are depressed, usually to a moderate degree, in association with hypochromia, microcytosis, and modest poikilocytosis
Peripheral smear showed elliptocytes which were more than 50%, there was marked anisocytosis, poikilocytosis
and red cell fragmentation (fig-1a).