Pencil cells and prekeratocytes in iron deficiency anemia

✍ Scribed by Alexandra M. Harrington; Steven H. Kroft

• Publisher: John Wiley and Sons
• Year: 2008
• Tongue: English
• Weight: 95 KB
• Volume: 83
• Category: Article
• ISSN: 0361-8609
• DOI: 10.1002/ajh.21283

✦ Synopsis

In addition to the morphologic features of microcytosis and hypochromasia, peripheral blood smears of iron deficiency anemia cases may contain various poikilocytes, including pencil cells (top left) and prekeratocytes (top right, bottom left) . Pencil cells are hypochromic variants of elliptocytes having long axes at least triple the length of the cell's short axis . They have been traditionally described in smears of iron deficiency; however, pencil cells may also be seen less commonly in other processes, including b-thalassemia minor and anemia of chronic disease . Similarly, the prekeratocyte, an infrequently referenced poikilocyte, is not exclusively seen in iron deficiency smears. Prekeratocytes are red blood cells with predominantly single, sharply defined, submembranous vacuoles in red cells with central pallor . They are seen in increased number in iron deficiency anemia compared with other microcytic states [1], but have been identified in b-thalassemia minor, anemia of chronic disease, and microangiopathic hemolytic anemia. Prekeratocytes are thought to be the precursors of keratocytes (bottom right), the latter presumably resulting from rupture of the submembranous vacuole.