What is poikilocytosis?
When a person’s blood shows the presence of poikilocytes or abnormally shaped red blood cells (RBCs), the person suffers from a condition known as poikilocytosis.
Abnormally shaped blood cells are common in many domestic animals.(1) However, such blood cells are very rare in humans.
The plasma of human blood comprised of many white blood cells and red blood cells. While the red blood cells serve the function of transferring oxygen to the vital parts and organs in the body, white blood cells together serve a number of functions in the body.(2)
An increased number of poikilocytes can be life-threatening for the individual too. These abnormal red blood cells can interfere with blood circulation, oxygen transfer and nutrient supply.(3)
Although poikilocytes are commonly found in human blood plasma, they are limited to certain numbers. Medically proven numbers of poikilocytes in human blood are close to 10 percent of the total blood cells.(4)
When increased number of poikilocytes are detected in your blood cells, it can cause various problems. Most patients with this disorder are treated for blood deficiency and vitamin deficiency.
Types
Blood poikilocytes are found in various shapes, sizes and numbers. Some of the common poikilocytes are burr cells, target cells, teardrop cells, spur cells and keratocytes, and the elliptocytes.(5)
The shape and size of each of these poikilocytes vary from each other. In addition to these cells, poikilocytes can be found in many other peculiar forms and shapes too.
Causes
The cause of poikilocytosis can be due to many reasons. The major cause of this disorder in humans is due to vitamin deficiency.(3)
Studies on this disorder reveal that lack of folic acid in food can lead to vitamin deficiency and poikilocytosis in human beings.
Symptoms
Because of the abnormally shaped cells in poikilocytosis, blood circulation becomes a major problem. The normal size of the blood cells is small and circular in shape.
Therefore, blood cells easily carry oxygen and pass through the tiniest blood vessel without having any problem. Due to the huge and deformed shape of poikilocytes, the blood plasma becomes unable to carry them to all parts of the body.
When blood cells cannot transfer oxygen to various vital organs, the person can suffer from moderate to severe anemia.(6)
In the case of a high number of sickle cell poikilocytes, the person can fall under the category of blood cancer too. Patients with leukemia can also develop severe poikilocytosis.
Depending on the consequences, the affected individual may develop cardiovascular problems, breathing disorder and other problems in a course of time.
Normal RBCs perform many of the most vital biological activities in our body. When the blood circulation and oxygen transfer is reduced due to the abnormal RBCs, the overall body growth will be affected too.
Therefore, patients are more likely to observe a drastic weight loss, severe growth retardation, and nutrition deficiency.(7)
Heart diseases are also very common in people with poikilocytosis.(8) Plus, patients may experience many other symptoms depending on the underlying cause of the associated disease.
Diagnosis
To detect the problem, your healthcare provider will conduct a blood film test. This test would be conducted to see if the number of poikilocytes in the blood is higher.
The certain amount of blood sample will be drawn from the individual for this test. The technician will create a thin layer of blood film on the test slide and examines the shape of the blood cells under a high-resolution microscope.
After the test results, your doctor may order further blood work and even bone marrow testing if required. In a case of vitamin and nutrition deficiency, the person is given supplements immediately after the blood work results are out.
Differential blood count is another important test that is conducted to count the number of abnormal cells found in blood plasma. This is a confirmatory test after the initial blood film test.
Blood composition test also becomes necessary in order to detect the actual cause of the deficiency. In addition, medical practitioners also suggest patients undergo a hemoglobin test to find the exact range of RBCs.
This percentage analysis gives a clear picture of the severity of the poikilocytosis.
Treatment
Doctors don’t prescribe any treatment plan or medication until the underlying cause of poikilocytosis has been determined.
If the condition is celiac disease or anemia, doctors will treat the condition accordingly. However, an individual with sickle cell anemia may have to undergo further tests before any treatment.
Generally, poikilocytosis patients are treated with moderate lifestyle and dietary changes. Doctors also prescribe taking supplements such as folic acid and multivitamins to treat vitamin related deficiency.
In addition, doctors will initiate other medical treatments based on the underlying cause and the problem. Chemotherapy is the treatment option for patients with cancerous poikilocytosis.(9)
Prognosis
Patients diagnosed with poikilocytosis are often advised to follow some dietary changes and lifestyle changes. Because the underlying cause of such a condition is nutrient and vitamin deficiency, the treatment is focused on making lifestyle and dietary changes.
However, if the underlying cause is found different, doctors take another approach to treating the condition.
The chief aim of diet and lifestyle change is to incorporate a nutrient rich and healthy eating habit. By taking appropriate medications and supplements, patients can easily manage this condition.
Nutrients get absorbed in red blood cells, and it is possible to get back the normal RBCs in blood after a few weeks. Maintaining your health, therefore, is highly dependent on how you eat and manage your food.
Nutritional Deficiency
Managing nutritional deficiency is very important in poikilocytosis health condition. To allow the red blood cells to develop, your body requires high amounts of vitamin B12 and folic acid.
If the diet you follow doesn’t contain vitamin B12 rich food, your small intestine will be unable to absorb the essential nutrients required for the nutritional deficiency treatment.(10)
After diagnosed with this condition, patients are often given a supplement rich in vitamin B12 and folic acid to facilitate essential vitamin and mineral absorption.
Foods rich in iron will also help in normal growth and development of red blood cells.
Folic acid is a major nutrient for RBCs and their normal growth and development. Nutritional deficiency in poikilocytosis is always because of iron and folic acid deficiency.(11)
These can sometimes deform the RBCs structure. This deficiency can lead to structural deformity of RBCs, which often leads to the condition of poikilocytosis.
Patients, therefore, should follow their diet chart and take the prescribed supplement to improve their condition.
Dietary Changes
To supply your body with vitamin B12 and other nutrients, you should focus on a diet rich in protein, animal protein, soy products, lentils and whole grains and folic acid rich foods, including beetroot, spinach, broccoli, and almond.
Leafy green vegetables are rich in folic acid and iron, ideal for treating the nutrition deficiency in poikilocytosis.
Some patients may need to follow a gluten-free diet if the poikilocytosis is identified as a celiac disease. To control this disease, you should follow a wheat and soy free diet.
Your nutritionist will design a diet plan for you to improve the celiac disease condition.
Conclusion
Seeing your healthcare provider is the first order of business if you have symptoms that worry you.
Before initiating the treatment and prescribing a diet plan for patients with poikilocytosis, it is important for the healthcare provider to let the patients know about the cause, importance of lifestyle changes and disease progression.
Poikilocytosis can be managed well if the disease is due to nutritional deficiency or by a digestive disease.
Take the lifestyle and dietary changes positively to improve your condition and manage the symptoms of poikilocytosis easily.
Poikilocytosis sounds like one of those medical words that should come with a pronunciation guide and, honestly, maybe a snack. In plain English, it means some of the red blood cells seen on a blood smear are abnormally shaped.
Normally, red blood cells are round, slightly flatter in the middle and flexible enough to squeeze through tiny blood vessels. When too many of them are misshapen, they may not carry oxygen as well or may break down sooner than they should.
What Is Poikilocytosis?
Poikilocytosis is usually not a disease all by itself. It is a lab finding that tells your health care provider, “Something may be affecting the red blood cells, and we should figure out what.”
A pathologist or lab professional may report poikilocytosis after looking at a peripheral blood smear, which is a thin layer of blood examined under a microscope. As noted in this poikilocytosis review from LabCE, different red blood cell shapes can offer clues about different possible causes.
To be clear, one funny-looking red blood cell is not typically a reason to panic. The concern is when a meaningful number of red blood cells are abnormal, or when poikilocytosis shows up along with anemia, abnormal iron levels, jaundice, bleeding symptoms or other changes in health.
You may also see the term anisopoikilocytosis on a report. That simply means red blood cells vary in both size and shape, because apparently one complicated blood word was not enough.
Common Types of Abnormally Shaped Red Blood Cells
There are several types of poikilocytes, and yes, the names do get a little intense. The important part is not memorizing every shape, but understanding that the shape can help point your medical team in the right direction.
- Sickle cells: Crescent-shaped red blood cells most often linked with sickle cell disease.
- Schistocytes: Broken or fragmented red blood cells, which can be seen when red blood cells are being damaged in the bloodstream.
- Target cells: Red blood cells that look like a bullseye and may be seen with liver disease, thalassemia, some hemoglobin disorders or after spleen removal.
- Elliptocytes or ovalocytes: Oval-shaped cells that may appear with hereditary elliptocytosis, iron deficiency anemia or vitamin B12 and folate deficiency.
- Spherocytes: Rounder, denser-looking red blood cells that can show up in hereditary spherocytosis or autoimmune hemolytic anemia.
- Teardrop cells: Cells shaped like a drop of water, sometimes seen with bone marrow disorders, severe iron deficiency or thalassemia.
- Acanthocytes: Spur-like cells that may be associated with severe liver disease or rare inherited lipid disorders.
- Echinocytes: Burr-like cells that may be linked with kidney disease, but can also happen because of how a blood sample was handled.
This is exactly why a lab result should be interpreted by a clinician rather than Googled at midnight. The same cell shape can sometimes have more than one explanation, and context matters more than any single word on a report.
What Causes Poikilocytosis?
Poikilocytosis can happen for many reasons, ranging from common nutrient deficiencies to inherited blood conditions. In many cases, it is connected to anemia, which means the body does not have enough healthy red blood cells to carry oxygen well.
The National Heart, Lung, and Blood Institute lists nutritional deficiencies, blood loss, inherited conditions, chronic disease and bone marrow problems among the major causes of anemia. Poikilocytosis can show up in several of these situations.
Iron Deficiency Anemia
Iron deficiency is one of the most common reasons red blood cells can become smaller, paler or oddly shaped. This may happen from heavy menstrual bleeding, pregnancy, low iron intake, digestive bleeding or problems absorbing iron.
Someone with iron deficiency may have fatigue, weakness, shortness of breath, headaches, brittle nails or cravings for non-food items like ice. And yes, craving ice is one of those strange body clues that is worth mentioning to your doctor.
Vitamin B12 or Folate Deficiency
Vitamin B12 and folate are needed to make healthy red blood cells. When either is low, red blood cells may become larger than normal, and abnormal shapes may appear on the smear.
This can happen with low intake, certain medications, digestive conditions, bariatric surgery or pernicious anemia, which affects vitamin B12 absorption. Symptoms may include fatigue, pale skin, a sore tongue, numbness, tingling or balance problems, especially when B12 is involved.
The National Institutes of Health Office of Dietary Supplements notes that vitamin B12 deficiency can cause neurological symptoms, and those symptoms may become serious when deficiency is not treated. In other words, this is not one of those “I’ll just wait and see for six months” situations.
Inherited Blood Disorders
Some people are born with blood conditions that affect the shape, structure or hemoglobin inside red blood cells. Sickle cell disease, thalassemia, hereditary spherocytosis and hereditary elliptocytosis are a few examples.
For example, GeneReviews on sickle cell disease explains that sickled red blood cells can block blood flow and break down early, leading to anemia and painful episodes. These conditions are not caused by “bad eating” or something a person did wrong, which is important to say out loud.
The American Society of Hematology also describes sickle cell disease as an inherited disorder that can affect many organs over time. That is why people with inherited red blood cell disorders often need ongoing care, not just a one-time iron pill and a pat on the back.
Liver Disease
Liver disease can change the fats in red blood cell membranes, which may lead to target cells, spur cells or other abnormal shapes. Alcohol-related liver disease, cirrhosis and other chronic liver conditions can all affect the blood in this way.
In severe liver disease, the appearance of certain abnormal red blood cells may suggest the illness is more advanced. That is not meant to scare anyone, but it is a good reason not to ignore abnormal blood work.
Kidney Disease
The kidneys help make erythropoietin, a hormone that signals the body to produce red blood cells. In chronic kidney disease, anemia is common because the kidneys may not make enough of this hormone.
As noted by the National Institute of Diabetes and Digestive and Kidney Diseases, anemia in chronic kidney disease can contribute to fatigue, weakness, shortness of breath and dizziness. Burr cells may sometimes be seen on a smear, although sample handling can also create cells that look similar.
Bone Marrow Disorders
The bone marrow is where red blood cells are made. When the marrow is affected by conditions such as myelofibrosis, myelodysplastic syndromes or cancers involving the marrow, abnormal red blood cell shapes may appear.
Teardrop-shaped cells can sometimes be seen when the bone marrow is crowded or scarred. This kind of finding usually needs a more careful medical workup, often with a hematologist.
Hemolytic Anemia
Hemolytic anemia occurs when red blood cells are destroyed faster than the body can replace them. This can happen because of autoimmune disease, infections, medications, inherited conditions or mechanical damage to red blood cells.
As described in the Merck Manual’s overview of hemolytic anemia, symptoms may include fatigue, jaundice, dark urine and an enlarged spleen. When red blood cells are being broken apart, schistocytes may also be reported, and that can be medically urgent depending on the situation.
Symptoms of Poikilocytosis
Poikilocytosis itself usually does not cause symptoms. The symptoms come from the condition behind it, especially when anemia or red blood cell destruction is present.
Common symptoms may include:
- Fatigue or low energy.
- Weakness.
- Shortness of breath, especially with activity.
- Dizziness or lightheadedness.
- Pale skin.
- Fast or irregular heartbeat.
- Cold hands and feet.
- Headaches.
- Yellowing of the skin or eyes.
- Dark urine.
- Chest discomfort with exertion.
Some people have no symptoms at all and only learn about poikilocytosis after routine blood work. Not very dramatic, but honestly, that is often how blood issues are first found.
How Is Poikilocytosis Diagnosed?
Poikilocytosis is usually found through a complete blood count, called a CBC, and a peripheral blood smear. The CBC gives information such as hemoglobin, hematocrit, red blood cell count and red blood cell size, while the smear gives a closer look at the actual shape of the cells.
Your provider may order more tests depending on what the smear shows. Common follow-up tests include iron studies, ferritin, vitamin B12, folate, reticulocyte count, bilirubin, lactate dehydrogenase, haptoglobin, liver enzymes, kidney function tests and other tests for hemolysis.
Sometimes genetic testing, hemoglobin electrophoresis or bone marrow testing may be needed. That does not mean everyone with poikilocytosis needs an invasive workup, but it does mean the next step should be personalized.
It is also worth remembering that lab results can be affected by timing, hydration, inflammation, recent illness and even how the sample was collected or stored. Annoying, yes, but very true.
How Is Poikilocytosis Treated?
There is no single treatment for poikilocytosis because the goal is to treat the cause. In other words, you do not treat the weird-shaped blood cells as much as you treat the reason they became weird-shaped in the first place.
Iron deficiency may be treated with iron supplements and by finding the reason iron is low. That may be as simple as heavy periods, or it may require checking for digestive blood loss, especially in adults.
Vitamin B12 deficiency may be treated with oral B12 or injections, depending on the cause and how well the body absorbs it. Folate deficiency is usually treated with folic acid, but B12 should be checked too, because treating folate alone can hide B12 deficiency while nerve problems continue.
Inherited disorders like sickle cell disease or thalassemia may require ongoing care from a hematologist. Treatments can include medications, transfusions, folic acid, pain plans, infection prevention and, in selected cases, more advanced therapies.
Autoimmune hemolytic anemia may require medications that calm the immune system. Severe or urgent cases of red blood cell destruction may need hospital care, transfusion or specialized treatment.
Liver disease, kidney disease and bone marrow disorders each have their own treatment paths. The main point is that poikilocytosis is a clue, not the final diagnosis.
Can Diet Help?
Diet can help when poikilocytosis is related to a nutrient deficiency, and that is where food really can pull its weight. Iron, vitamin B12, folate and overall protein intake all matter for healthy red blood cell production.
Iron-rich foods include beef, poultry, seafood, beans, lentils, tofu, spinach and fortified cereals. Pairing plant-based iron foods with vitamin C foods, such as citrus, strawberries, bell peppers or tomatoes, can help improve iron absorption.
Vitamin B12 is found mainly in animal foods such as fish, meat, poultry, eggs and dairy, as well as fortified foods. People following a vegan diet usually need a reliable B12 supplement or fortified foods, because plants are not dependable sources of B12.
Folate is found in leafy greens, beans, lentils, asparagus, avocado and fortified grains. Basically, this is one more reason beans and greens keep showing up in nutrition advice, and no, they are not just there to ruin dinner.
That being said, food is not always enough. When a deficiency is significant, or when absorption is the issue, supplements or medical treatment may be needed.
Also, please do not start high-dose iron just because you are tired and the internet told you to. Too much iron can be harmful, and it is much smarter to confirm deficiency with lab work first.
When Should You See a Doctor?
You should follow up with a health care provider if a blood test shows poikilocytosis, especially if you also have low hemoglobin, abnormal iron studies or symptoms of anemia. It is also important to seek care if you have heavy bleeding, unexplained weight loss, yellowing of the skin or eyes, dark urine or worsening shortness of breath.
Get urgent medical help for chest pain, fainting, severe weakness, confusion, sudden shortness of breath or signs of stroke. Those symptoms are never something to “watch for a few days.”
Bottom Line
Poikilocytosis means red blood cells are showing up in abnormal shapes, usually on a blood smear. It is not usually a diagnosis by itself, but it can point toward anemia, nutrient deficiencies, inherited blood disorders, liver disease, kidney disease, hemolysis or bone marrow problems.
The good news is that many causes are treatable once they are identified. The not-so-good news is that guessing the cause based on symptoms alone is not a great plan, so the smartest next step is reviewing the blood work with a qualified clinician and getting the right follow-up tests.