This week’s Morphology Monday case featured a 60-year-old female whose full blood count prompted further investigation:
Full blood count results:
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WBC: 11.58 ×10⁹/L
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RBC: 3.16 ×10¹²/L
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Hb: 84 g/L
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HCT: 0.256
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MCV: 81 fL
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MCHC: 328 g/L
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RDW: 22.5%
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PLT: 669 ×10⁹/L
A blood film review was requested following a low haemoglobin level and markedly raised platelet count. The film revealed a dimorphic red cell population, with both normocytic-normochromic and hypochromic cells present. Numerous target cells, occasional Howell-Jolly bodies, and basophilic stippling were also noted.
These findings raised the possibility of a haemoglobinopathy. Given the red cell morphology and raised RDW, follow-up testing was advised.
Key learning points:
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A dimorphic red cell picture with target cells and stippling should raise suspicion for haemoglobinopathies.
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Howell-Jolly bodies may point to functional hyposplenism or splenic absence, warranting further clinical correlation.
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Thalassaemia can present with a normal MCV if there’s co-existing normocytic cell production.