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Poikilocytosis Defination, Types, Causes, Symptoms and more

Poikilocytosis is a term that refers to the presence of abnormally shaped Red Blood Cells (RBCs), called poikilocytes. Because poikilocytosis is often a symptom of another condition, treatment options vary depending on the underlying cause.

Normal red blood cells (also called erythrocytes) are typically disk-shaped, thinner in the middle than at the edges, with a diameter of 6.2 to 8.2 micrometers, a thickness at the thickest point of 2 to 2.5 micrometers, and a thickness at the center of 0.8 to 1 micrometer. Poikilocytosis generally refers to an increase in the number of abnormally shaped red blood cells that represent 10% or more of the total red blood cells.

Poikilocytoses may be flat, elongated, teardrop-shaped, or crescent-shaped, or may have pointed or spiny projections, or may have other abnormal features. This activity reviews the assessment and treatment of poikilocytosis and emphasizes the role of the interprofessional team in the management of patients with this condition.

Objectives:

Identify the pathophysiology of poikilocytosis.
Describe the appropriate evaluation of common causes of poikilocytosis.
Review the treatment options available for the different types of medical conditions associated with poikilocytosis.
Summarize interprofessional team strategies to improve coordination and communication of care to improve the care of patients with poikilocytosis and improve patient outcomes.

What is Poikilocytosis?

Poikilocytosis (pronounced “po-kuh-low-sai-TOW-suhs”) is a term used by healthcare professionals to describe abnormally shaped red blood cells. In poikilocytosis, more than 10% of the red blood cells in a blood sample are not shaped like normal red blood cells.

Key Points:

Poikilocytosis is a term used to refer to abnormally shaped red blood cells in the blood.
Poikilocytosis refers to an increase in the number of abnormal red blood cells of any shape that make up 10% or more of the total population.
Poikilocytoses may be flat, elongated, teardrop-shaped, crescent-shaped, sickle-shaped, or may have pointed or spine-like projections, or may have other abnormal features.
Poikilocytosis may be due to hereditary or acquired causes. Hereditary diseases are due to a genetic mutation. Acquired diseases usually develop later in life.
The most common etiologies of poikilocytosis are sickle cell disease, thalassemia, hereditary spherocytosis, iron deficiency anemia, megaloblastic anemia, and liver disease.
The most common types of poikilocytosis are sickle cell, target cell, spherocyte, elliptocyte, oval, echinocyte, and acanthocyte.
They are usually identified on the blood smear and play an important role in the diagnosis of the underlying cause and its management. Treatment and prognosis vary depending on the cause of poikilocytosis.

Types of Poikilocytosis:

‌To understand the causes of poikilocytosis and start treatment early, it is necessary to know the different types or shapes of cells. The most common types are:

Sickle cells (Drepanocytes)
Sphere or round-shaped cells (Spherocytes)
Teardrop cells (Dacrocytes)
Spur cells (Acanthocytes)
Fragmented, irregularly shaped cells (Schistocytes)
Oval or elongated cells (Elliptocytes)
Target cells (Codocytes)
Burr cells (Echinocytes)‌‌

Abnormal Shapes of Red Blood Cells (Poikilocytes):

Doctors classify abnormal shapes of red blood cells based on their characteristics. With poikilocytosis, you may have one or more of the following abnormal cells, or poikilocytes:

Acanthocytes (spur cells): Cells with spikes of different lengths and widths that protrude from the cell membrane.
Codocytes (target cells): Cells with a dark center in the middle, resembling a target.
Dacrocytes (teardrop cells): Cells that taper or end in a point on one side, like a teardrop.
Sickle cells: Thin, curved cells that resemble a sickle or crescent.
Echinocytes: Cells covered with regularly spaced, spiny projections, like a sea urchin.
Elliptocytes (ovalocytes or cigar-shaped cells): abnormally long oval cells, ranging in shape from an egg to a cigar. Schistocytes: fragments of red blood cells that are usually irregular, but can have any shape.
Spherocytes: spherical cells that resemble a ball or balloon.

What are the symptoms of poikilocytosis?

Symptoms depend on the cause of the poikilocytosis. The most common symptoms are the same as those of anemia.

Symptoms of anemia include:

Weakness or fatigue.
Difficulty breathing (dyspnea).
Rapid or irregular heartbeat (arrhythmia).
Occasional “ringing” in the ear (pulsatile tinnitus).
Headache.
Dizziness.
Pale skin.
Chest pain.

Causes of Poikilocytosis:

Medical causes of poikilocytosis vary depending on the type of cell shape. Common causes of abnormal red blood cells include:

Sickle cells (sickle-shaped cells): sickle cell disease
Spherocytes (sphere-shaped or round): autoimmune disorders, transfusion reactions, newborn illnesses, or snake bites
Dacrocytes (teardrop-shaped cells): leukemia, megaloblastic anemia, or myelofibrosis
Acanthocytes (stimulator cells): liver disease, kidney disease, thalassemia, autoimmune hemolytic anemia, or McLeod syndrome
Schistocytes (fragmented, irregularly shaped cells): hemolytic anemias, burns, sepsis, and platelet disorders.
Elliptocytes (oval or elongated cells): Iron deficiency, myelofibrosis, or megaloblastic anemia
Codocytes (target cells): Liver disease, iron deficiency, hemoglobin C disease, or spleen ablation
Echinocytes (burr-shaped cells): Pyruvate kinase enzyme deficiency, kidney disease, or cancer

How is poikilocytosis diagnosed?

A health care professional may perform a peripheral blood smear (PBS) to diagnose poikilocytosis. During this test, a lab technician examines a sample of blood under a microscope. He or she will be able to determine how many oddly shaped cells you have and what type they are.

Treatment for poikilocytosis:

Treatment for poikilocytosis depends on the underlying cause of the poikilocytosis. In cases where poikilocytosis is caused by iron deficiency anemia, megaloblastic anemia due to low levels of iron, vitamin B12, or folate, respectively, it is usually treated by taking supplements and increasing the levels of these vitamins in the diet and/or treating the underlying disease (such as celiac disease or alcoholism) that caused the deficiency.

References:

Poikilocytosis – StatPearls – NCBI Bookshelf By Sai Samyuktha Bandaru; Robert B. Killeen; Vikas Gupta.| https://www.ncbi.nlm.nih.gov/books/NBK562141 – (Accessed on Sep 19, 2024)
Poikilocytosis: Causes, Symptoms & Treatment – Cleveland Clinic | https://my.clevelandclinic.org/health/diseases/24793-poikilocytosis – (Accessed on Sep 19, 2024)
Poikilocytosis: Abnormal Shaped Blood Cells – WebMD – Better information. Better health. Medically Reviewed by Kumar Shital, DO on September 14, 2023 | https://www.webmd.com/a-to-z-guides/what-is-poikilocytosis – (Accessed on Sep 19, 2024)
What to know about poikilocytosis – Medical News Today – Medically reviewed by Alana Biggers, M.D., MPH — Written by Christine Richardson on October 19, 2021 | https://www.medicalnewstoday.com/articles/poikilocytosis – (Accessed on Sep 19, 2024)
American Family Physician: “Anemia in Children.” – (Accessed on Sep 19, 2024)
Hematology: “New diagnostic tools for delineating iron status.” – (Accessed on Sep 19, 2024)
‌Hospital of the Good Samaritan Medical Center and the University of Southern California School of Medicine: “Poikilocytosis in Cancer Patients.” – (Accessed on Sep 19, 2024)
‌Mayo Clinic Proceedings: “How to Interpret and Pursue an Abnormal Complete Blood Cell Count in Adults.” – (Accessed on Sep 19, 2024)
‌Mount Sinai: “Blood smear.” – (Accessed on Sep 19, 2024)
StatPearls: “Poikilocytosis.” – (Accessed on Sep 19, 2024)
‌Sumy State University: “Poikilocytosis in the Acne Vulgaris Comorbidity with Demodicosis and Functional Gallbladder Disorder.” – (Accessed on Sep 19, 2024)