I am diagnosed with anisopoikilocytosis. Do these misshapen cells pose any danger?

Question

Hello doctor,

I am a 53-year-old woman diagnosed with polycythemia vera (PV) three years ago. I am being treated with phlebotomy. I have fatigue at times, as well as some thinking impairment at times. Over time, I have developed various anomalies in my blood test results, which my doctor explained as normal.

For instance, I typically have one positive anisocytosis, two positive hypochromia, and two positive microcytes. I have had occasional ovalocytes mentioned, as well as large platelets and, at times, giant platelets. My last complete blood count (CBC) mentioned there were a few schistocytes.

My question is this: I understand that these are all blood cells that are misshapen due to the polycythemia vera (PV) or to the chronic phlebotomies I receive. Are these misshapen cells a danger in and of themselves, or are they only indicators of a problem? How many weird cells can I have running around?

Kindly help.

Answer 1

Hi,

Welcome to icliniq.com.

Based on your query regarding polycythemia, my opinion is as follows:

Due to nutritional deficiencies, secondary to excessive RBC (red blood cell) production and also mild dyserythropoiesis (defective development of red blood cells), you can find microcytic hypochromic cells ( due to iron deficiency) and ovalocytes (due to vitamin B12 and folic acid deficiency).

Vitamin B12 and folic acid can impact other cell lines, resulting in hypersegmented neutrophils and giant platelets also.

As there is an iron deficiency, anisocytosis (unequal-sized red cells) and poikilocytosis (abnormally shaped red cells) are seen. The more the iron deficiency, the higher the percentage of anisopoikilocytosis.

Schistocytes (irregularly shaped red cells) could be due to marrow fibrosis or red cell trapping in fibrin fragments. The former usually occurs in the marrow at a later stage of polycythemia vera. At present, schistocytes could be due to dyserythropoiesis in the marrow. No fibrin trapping can be thought of.

Things that need to be watched are any reduced counts of red blood cells, white blood cells, or platelets. This will occur before the increase in schistocytes. Bone marrow fibrosis due to the burning out phase will lead to pancytopenia (deficiency of RBC, WBC, and platelets) and schistocytes. As all other counts are normal, you need not worry about schistocytes for now.

Schistocytes percentage more than 5 percent, or specifically 10 percent, should be worrisome. It usually does not occur in PV, unless it is a late stage, with marrow fibrosis and pancytopenia.

Revert back to a hematologist online for further follow-up.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com

You are always welcome. Take care of your health.

For further information, consult a hematologist online.

Thank you.