Elliptocytes and tailed poikilocytes correlate with severity of iron-deficiency anemia

This study examines the relationships between abnormal RBC morphology, RBC indices measured with an automated hematology analyzer, serum iron studies, and severity of anemia in patients with findings indicative of iron-defici ency anemia. Counts and morphologic classification of 1,000 RBCs from each of 22 patients,1 ere performed, and correlations were determined between pa rameters. The Student t test was rued to determine the level of significanc e for correlations between parameters. Several significant relationships we re found. As the percentage of elliptocytes increased, hemoglobin concentra tion, hematocrit, RBC concentration, and mean corpuscular hemaglobin level decreased (r = .48, .44. .40, and .49, respectively; P < .05). As the perce ntage of tailed poikilocytes increased, hemoglobin concentration, hematocri t, and RBC concentration decreased (r = .70, .77 and .71, respectively; P < .01) and RBC distribution width increased (r = .73; P < .01). Of significa nce, serum ferritin levels, long considered the best single indicator of ir on deficiency, showed no correlation with the morphologic abnormalities ass essed, severity of anemia, or any of the analyzer-generated indices. Our re sults indicate that microscopic evaluation of RBC morphology remains an imp ortant tool for the pathologist to evaluate the severity of anemia in patie nts with iron deficiency.