Saturday, May 20, 2017



Poikilocytosis is a condition characterized by presence of abnormally shaped red blood cells (poikilocytes) in the blood. 

The poikilocytes make up 10% or more of the total population of red blood cells. It is rare in humans, but common in domestic animals. The shape of a normal red blood cells is round and looks like a flattened disk. Normal RBCs are thinner in the middle as compared to the edge. 

An increased number of abnormal red blood cells can cause various problems. It could interfere with the proper circulation of blood including the transfer of oxygen and supply of nutrient. The supply of oxygen in the blood will significantly reduce, which could lead to the development of various health disorders. (1)

What causes abnormally shaped red blood cells?

Poikilocytosis can be caused by many factors. It primarily linked with vitamin deficiency and reduced folic acid in the blood. If the blood lacks folic acid, vitamin deficiency follows.

What is the meaning of Anisocytosis?

Anisocytosis pertains to red blood cells that are different in sizes. What is the difference between anisocytosis and Poikilocytosis? With anisocytosis, the size is unequal whereas in Poikilocytosis, it is the shape that is irregular. Unequal size of red blood cells possess danger to your health because it can greatly affect the transport of oxygen. The red blood cells will have a hard time disseminating oxygen in an efficient manner. (2, 3)

What are the causes of Anisocytosis?

  • Anemia
  • Vitamin deficiency, specifically vitamin A, B12, and folate deficiency.
  • Iron deficiency (3)

What are poikilocytosis symptoms?

Poikilocytosis symptoms are somewhat similar to that of anisocytosis. The patient will experience anemia-like symptoms including the following:
  • Unexplained weight loss
  • Easy fatigability
  • Pale skin
  • Weakness
  • Rapid heart rate
  • Poor concentration due to lack of oxygen supply in the blood (4)
Picture 1 : Red blood cells in their degenerative forms.
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Figure 2 : A microscopic view of the normal structure of red blood cells
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Classifications of Poikilocytosis

  • Teardrop cell (Dacrocytes) – The shape of the RBC is similar to teardrop. It is linked with diseases like myelofibrosis with myeloid metaplasia.
  • Target cells (Codocytes) – The red blood cells are like bull’s eye. In the center of the cell, you will see the haemoglobin. It is linked with liver cirrhosis, splenectomy, anemia, thalassemia, iron deficiency anemia, and hemoglobinopathies.
  • Spherocyte – The RBCs are small and rounded (sphere-shaped), which is linked with anemia, severe burn, jaundice in newborn, immune mediated haemolytic anemia, and genetic spherocytosis.
  • Sickle cell (Drepanocytes) – The RBCs look like thorns and the haemoglobin is S-shaped. It is linked with sickle cell anemia.
  • Schistocyte – The RBCs has no definite shape and size. It is linked with platelet disorders like purpura, thrombocytosis, haemolytic uremic syndrome, coagulation disorder, and severe burn.
  • Acanthocyte – The red blood cells are irregularly arranged and has irregularly spiked cell membranes. It is associated with severe liver disease, microangiopathic haemolytic anemia, vitamin E deficiency, hypothyroidism, and abetalipoproteinemia.
  • Stomatocyte (mouth cells) – The RBCs are cup shaped and have a split in the center making them look like kissing lips. They are linked with diseases like hereditary stomatocytosis, alcoholism, and hepatic disorder.
  • Ovalocyte – The red blood cells look like a pencil. It is linked with anemia, hereditary elliptocytosis, and thalassemia.
  • Bite cell (Degmacytes) – It looks like a bite is taken out from the red blood cells. If the cells look like a bite, it is because the patient is suffering from haemolytic anemia, G6PD, liver cirrhosis secondary to excessive intake of alcohol, and poisoning.
  • Echinocyte/burr cells – The RBCs are abnormally small and have rounded structure at the outer edge. This indicates that the patient is suffering from severe stomach disease such as cancer, uremia, pyruvate kinase deficiency, and ulceration.
  • Semilunar bodies – The cells have a crescent shape. The haemoglobin is completely loss that is why it is also called the ghost cells or phantom cells.
  • Microspherocytes – The diameter of the cell is smaller than the usual, but it is thicker.
  • Pyropoikilocytes – This type of cell is sensitive to heat.
  • Keratocytes – This is caused by severe trauma. Before the cells become keratocyte, they have blisters and ruptures. A keratocyte cell looks like a helmet with a strap. (2)

How to diagnose poikilocytosis?

Blood Film Test

This test is done to check if the number of abnormal shaped red blood cells is higher than usual. A blood sample is drawn and the medical technician will create a thin layer of blood film on the slide. Using a microscope, the shape of the red blood cells will be thoroughly examined.

Depending on the result of the test, the doctor might request for further blood work to thoroughly assess the condition of the patient and to be able to come up with the best treatment management. (5)

Differential Blood Count

The purpose of this test is to count the number of abnormal cells in the blood. This is usually ordered together with the blood film test.

Blood Composition Test

This test is used to detect the root cause of the deficiency. To find out the exact composition of red blood cells, a haemoglobin test is ordered. This test gives a clear picture as to how severe poikilocytosis is. Hemoglobin is the main protein composition of the red blood cells.

The ideal number of haemoglobin ranges between 14-18 milligrams/deciliter. If the result turns out to be lower than the average, then you are suffering from haemoglobin deficiency. (6)


A patient with poikilocytosis is advised to change his diet and lifestyle. The focus of care is to improve the vitamin and nutrient level in the body. This can only be achieve through diet and lifestyle modification. As with the underlying cause of poikilocytosis, the doctor will come up with the best possible remedy to cure the underlying cause. (7)

If the number of abnormal shaped red blood cells goes out of control, it could indicate a more serious problem. The patient could be suffering from celiac disease, sickle cell disease, or anemia. The underlying medical condition should be treated with drug therapy and lifestyle change.

For vitamin deficiency, the patient should take folic acid supplement and essential vitamins like A, C, and B complex. The patient is strongly advised to eat healthy and nutritious foods. Nutrients from foods and supplements can be easily absorbed by red blood cells. Hence, after a few weeks, the red blood cells will go back to their normal range. (8)

The importance of folic acid in the blood

For patients with poikilocytosis, it is a must to manage nutritional deficiency. For the red blood cells to be healthy, it is important to have sufficient amount of vitamins, especially folic acid and vitamin B12. These vitamins facilitate the absorption of essential nutrients in the small intestines. Folic acid, in particular plays a major role in the blood.

It affects the growth and development of red blood cells. If you have poikilocytosis, it could also mean one thing, you don’t have enough folic acid in the blood. This is the prime reason why there is a deformity in the structure of red blood cells. To significantly improve the condition, patients are strongly advised to eat folic acid rich foods and take folic acid supplement religiously. 

As mentioned above, dietary changes should be made. There are foods you should include in your diet as well as foods you should completely eliminate from your diet. Foods you need to include in your day to day diet include protein rich foods like soy products, protein from animal sources, whole grains, and lentils. Folic acid rich foods are also important.

Examples of folic acid rich foods are broccoli, spinach, almond, and beetroot. Patients should also increase their intake of green leafy vegetables. There are certain food groups patients should avoid such as gluten rich foods. It should be strictly followed by patients whose poikilocytosis is caused by celiac disease. You will need the help of a nutritionist to lay out the best diet plan for poikilocytosis secondary to celiac disease. (9, 10)