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Blood film features:
- Anisopoikilocytosis
- Microcytic, hypochromic
- Elliptocytes, particularly very narrow elliptocytes – “pencil cells”
- Pre-keratocytes and keratocytes
- Some target cells (less than beta thal trait)
- Occasional teardrops
- May have reactive thrombocytosis
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This blood film is from a patient with polycythaemia vera. The patient also has a concomitant iron deficiency, as evidenced by the microcytosis, numerous elliptocytes and occasional keratocytes.
Differential diagnosis:
- Thalassaemia trait (prominent target cells and basophilic stippling, high RBC count with hypochromic RBCs)
- Anaemia of chronic disease (rouleux, reactive leukocytosis)
- Polycythaemia with iron deficiency (high RBC count with hypochromic RBCs, may have leukocytosis or thrombocytosis with platelet anisocytosis)
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