Her peripheral blood smear was negative for spherocytes and polychromasia
, despite Coombs posidvity.
One positive case with the presence of polychromasia
, PLT clumps, and giant PLTs was missed by the criteria.
9 Platelets * * * Mean Platelet Volume * * * Neutrophils 7 29 58 Bands 54 50 35 Lymphocytes 10 9 5 Monocytes 7 0 2 Metamyelocyte 12 9 0 Myelocyte 8 2 0 Promyelocyte 2 1 0 Nucleated Red Blood Cells 2 0 2 Polychromasia
present [dagger] [dagger] Poikilocytosis present [dagger] present Anisocytosis present [dagger] present Microcytes present [dagger] [dagger] Spherocytes present [dagger] [dagger] Mega-thrombocytes present present [dagger] Absolute Neutrophils 3.
All data were normally distributed except for percent polychromasia
which was square-root transformed.
Laboratory findings Suggest haemolysis * Full blood count: reticulocytosis with or without low Hb; mild macrocytosis * Blood smear: polychromasia
and basophilic stippling * Liver function test: increased unconjugated bilirubin and LDH or AST To confirm haemolysis * Decreased haptoglobin Features suggestive of intravascular haemolysis * Haemoglobinaemia * Haemoglobinuria * Haemosiderinuria Hb = haemoglobin; LDH = lactate dehydrogenase; AST = aspartate aminotransferase Table II.
A peripheral smear showed schistocytes, anisocytosis and polychromasia
suggesting microangiopathic hemolytic anemia.
Results revealed anemia (hematocrit, 30%; reference interval, 37-47%), polychromasia
and anisocytosis, hypoalbuminemia (0.
The peripheral blood smear was notable for marked microcytosis, hypochromia, polychromasia
, poikilocytosis, and anisocytosis with numerous erythroblasts.
WBC Toxic granulations 28 Dohle bodies 5 Vacuolations 38 Smudge cells 32 Clefted lymphocytes 10 Hairy projections 2 Auer rods 2 RBC Anisocytosis 54 Poikilocytosis 31 Microcytosis 7 Macrocytosis 2 Hypochromasia 3 Polychromasia
35 Echinocytes (burr cells) 19 Dacrocytes (teardrops) 16 Spherocytes 6 Target cells 2 Acanthocytes 1 Ovalocytes 28 Schistocytes 5 Stomatocytes 2 Howell-Jolly bodies 1 Basophilic stipplings 5 Platelet Clumped platelets 3 Platelet satellitosis 5 Large platelets 8 Giant platelets 8 Overall Cell Morphology Code Concordance, Overall Type % Concordance, % WBC Toxic granulations 78.
and fine basophilic stippling were present in the red cells, and occasional Dohle bodies were seen within the neutrophils.
The blood film shows hypochromic microcytic red cells with varying degrees of anisocytosis and poikilocytosis, together with target cells and polychromasia
We describe a patient with a history of chronic microcytic anemia with peripheral schistocytosis, polychromasia
, and Pappenheimer bodies, treated empirically with chronic iron supplementation.