Critical Normoblastosis in Severe Microcytic Anemia

A case of severe microcytic anemia with normoblastosis (864/100 WBC): erythrocyte morphology, target cells, Howell-Jolly bodies, and analyzer scattergram.

Alena Azarenkova 1 min May 14, 2025

Blood smear: oxyphilic normoblasts, poikilocytosis, and target cells

Blood smear: cluster of normoblasts, marked aniso-poikilocytosis, and microcytosis

Blood smear: normoblasts, Howell-Jolly bodies, and marked polychromasia of erythrocytes

Blood smear: massive release of normoblasts, hypochromia, and poikilocytosis of erythrocytes

Digital blood smear: numerous normoblasts in one microscopic field of view

DIFF scattergram of a hematology analyzer with a characteristic pattern

🩸 Severe anemia + critically high level of nucleated red blood cells (NRBC 864/100 WBC) 👩‍🦰 Patient: female, 43 years old 🧪 Diagnosis not yet established, but the analysis raises serious suspicions. Parameters: WBC (white blood cells): 10.76 × 10⁹/L ⚪️ RBC (red blood cells): 3.42 × 10¹²/L 🔴 HGB (hemoglobin): 77 g/L ❗️⬇ HCT (hematocrit): 24.6% MCV: 71.8 femtoliters (↓ microcytosis) MCH: 22.4 pg MCHC: 313 g/L RDW-CV: 26.4% 📈 (significant anisocytosis) PLT (platelets): 687 × 10⁹/L ⬆ NRBC (nucleated red blood cells): 864/100 WBC ‼ Erythrocyte morphology: 🛑 Marked poikilocytosis 🎯 Target cells 👄 Stomatocytes 🌈 Polychromasia ↕ Anisocytosis 🔴 Howell-Jolly bodies 🔵 Basophilic stippling

🙏 The publication was kindly provided by clinical laboratory diagnostics physician Alena Azarenkova, St. Petersburg