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 Table of Contents  
BRIEF REPORT
Year : 2017  |  Volume : 8  |  Issue : 3  |  Page : 123-124

Clinico-hematological profile of dimorphic anemia


Department of Pathology, ANIIMS, Port Blair, Andaman and Nicobar, India

Date of Web Publication18-Sep-2017

Correspondence Address:
Biswajit Dey
Department of Pathology, ANIIMS, Port Blair, Andaman and Nicobar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joah.joah_40_17

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  Abstract 


Dimorphic anemia (DA) is characterized by two different cell populations. One population is of microcytic hypochromic and other being either normocytic or macrocytic. A retrospective study was undertaken to correlate and compare the clinico-hematological parameters in DA done over a period of 6 months. All cases of anemia diagnosed during this period were analyzed and all cases diagnosed as DA in the peripheral blood smear (PBS) were included in the study. In PBS, dual population was seen in 17.5% of cases of anemia (178), comprising microcytic hypochromic with normocytic normochromic red blood cells in 37.1% of cases (66) or macrocytes in 62.9% of cases (112). Pancytopenia was seen in 9.55% (17) cases and bicytopenia in 50.5% (90) patients. Only eight cases had bone marrow correlation. All marrows were hypercellular showing megaloblastic erythropoiesis. DA is one of the common anemia but is an undermined entity. In low-resource settings, clinical and hematological parameters are of paramount importance for diagnosis and guiding treatment.

Keywords: Anemia, dimorphic, macrocytes


How to cite this article:
Garg P, Dey B, Deshpande AH, Bharti JN, Nigam JS. Clinico-hematological profile of dimorphic anemia. J Appl Hematol 2017;8:123-4

How to cite this URL:
Garg P, Dey B, Deshpande AH, Bharti JN, Nigam JS. Clinico-hematological profile of dimorphic anemia. J Appl Hematol [serial online] 2017 [cited 2019 Nov 18];8:123-4. Available from: http://www.jahjournal.org/text.asp?2017/8/3/123/214999




  Introduction Top


Dimorphic anemia (DA) is characterized by two different cell populations. One population is of microcytic hypochromic and other being either normocytic or macrocytic.[1]

DA is one of the common anemia in India, but there is a paucity of literature regarding this entity. One study conducted in India showed the incidence of DA is found to be 12.5%.[2] This anemia should be recognized early since the treatment may be ineffective if not diagnosed accurately. Therefore, this retrospective study was conducted to find the prevalence and to correlate the clinico-hematological parameters diagnosed as DA on peripheral smear.


  Materials and Methods Top


The study was conducted in the Department of Pathology over a period of 6 months from January 1, 2016, to June 30, 2016. This was a hospital-based retrospective study. Only those cases reported as DA on the peripheral blood smear (PBS) were included. Two milliliters of ethylenediaminetetraacetic acid blood was collected for complete blood counts using an automated five-part Mindray coulter machine. Bone marrow aspirates (BMAs) wherever available were included to confirm the peripheral smear findings and to assess the iron stores. All BMAs were stained with Perl's stain for hemosiderin and graded as per Gale et al.[3] The patients were then grouped as mild (10–10.9 g%), moderate (7–9.9 g%), and severe (<7 g%) anemia based on their initial hemoglobin level. Only those patients of severe anemia were subjected to bone marrow aspiration.


  Results and Discussion Top


During this period of 6 months, there were a total of 1015 (62.3%) anemic cases. DA was found in 17.5% (178/1015) of all cases of anemia. Of 178 patients, 41 (23%) cases were mild, 74 (41.6%) cases were moderate, and 63 (35.4%) cases were labeled as severe anemia. Athar et al. found 12.5% of DA out of 41.4% total cases of anemia.[2] Rahim et al. found DA in 15% of cases, which is in concordance with our study.[4] In another study by Iqbal et al., DA was found in 42.70% of the patients.[5]

The ages of the patients ranged from 1 to 80 years, with a mean age of 36.7 years. The male to female ratio was 1:1.64. Pallor was seen in all the cases (100%), followed by fever, organomegaly, and bleeding [Table 1]. Andaman and Nicobar Islands have high prevalence of malaria and leptospirosis and are major causes of anemia in these islands.[6] Thus, the clinical presentation of fever and organomegaly corroborates these findings.
Table 1: Clinical presentations of the patients

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Pancytopenia was seen in 9.55% (17) cases and bicytopenia in 50.5% (90) patients. Athar et al. found pancytopenia in 18.96% and bicytopenia in 20.68% of cases.[2] Pancytopenia is a common hematological condition with varied etiology and DA is a known cause of pancytopenia.[7] Raphael et al. reported 8.75% of cases of DA presenting with pancytopenia, which is comparable to our study.[7]

Leukoerythroblastic picture was seen in four patients. In PBS, dual population was seen in all 178 cases. Microcytic hypochromic red blood cells (RBCs) with normocytic normochromic RBCs were seen in 37.1% of cases (66) and microcytic hypochromic RBCs with macrocytes were seen in 62.9% of cases (112). Macrocytes, macroovalocytes, and hypersegmentation of neutrophils were seen in 62.9% (112) patients. Macrocytosis and hypersegmented neutrophils in PBS are strong indicators of Vitamin B12 deficiency.[2]

Thrombocytopenia and leukopenia were seen in 42.6% (76) and 26.9% (48) patients, respectively [Table 2].
Table 2: Morphological findings in peripheral smear

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Only eight patients gave consent for bone marrow aspiration. All marrows were hypercellular, showing erythroid hyperplasia with megaloblastic erythropoiesis (100%). Giant metamyelocytes were seen in all the bone marrow. The iron stores were reduced (Grade 0–1+) in only one case and increased in seven cases.


  Conclusion Top


DA is one of the common anemia in developing countries like India and its neighboring countries but an undermined entity. It is characterized by two different cell populations, comprising microcytic hypochromic with normocytic normochromic RBCs or macrocytes. In low-resource settings, clinical and hematological parameters such as complete hemogram and PBS are the important clues for diagnosis and are of paramount importance in guiding further management.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bain BJ. Morphology of blood cells. In: Blood Cells: A Practical Guide. 5th ed. New Jersey: Wiley-Blackwell; 2014. p. 67-185.  Back to cited text no. 1
    
2.
Athar R, Khonglah Y, Raphael V, Pal A, Lynrah KG. Clinico-hematologic and biochemical profile of dimorphic anemia with bone marrow study. Internet J Lab Med 2014;6:1.  Back to cited text no. 2
    
3.
Gale E, Torrance J, Bothwell T. The quantitative estimation of total iron stores in human bone marrow. J Clin Invest 1963;42:1076-82.  Back to cited text no. 3
    
4.
Rahim F, Irshad A, Saiful I, Muhammad H, Alikhan TK, Qudsia B. Spectrum of hematological disorders in children observed in 424 consecutive bone marrow aspirations/biopsies. Pak J Med Sci 2005;21:433-6.  Back to cited text no. 4
    
5.
Iqbal SP, Kakepoto GN, Iqbal SP. Vitamin B12 deficiency – A major cause of megaloblastic anaemia in patients attending a tertiary care hospital. J Ayub Med Coll Abbottabad 2009;21:92-4.  Back to cited text no. 5
    
6.
Joseph B, Raj RB, Ruben R. Role of screening tests and anemia in a resource poor setting. Indian J Pathol Res Pract 2012;1:77-80.  Back to cited text no. 6
    
7.
Raphael V, Khonglah Y, Dey B, Gogoi P, Bhuyan A. Pancytopenia: An etiological profile. Turk J Haematol 2012;29:80-1.  Back to cited text no. 7
    



 
 
    Tables

  [Table 1], [Table 2]



 

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