Iron deficiency anemia perturbs erythrocyte morphology and may promote eryptosis

Iron deficiency anemia (IDA) represents a major public health concern in India, affecting mostly women of reproductive age due to increased iron demands throughout their reproductive life. However, specific erythrocyte morphology and its possible consequences in this population remain unexplored.

This study systematically examined erythrocyte abnormalities in reproductive-age women with IDA.

Twenty-five women diagnosed with IDA and 25 age-matched healthy women were recruited. Scanning electron microscopy, atomic force microscopy (AFM), flow cytometry, confocal laser scanning microscopy, and spectrophotometry were used in this study.

Patients with IDA showed significant counts of elliptocytes, microcytes, stomatocytes, and spherocytes, which were negatively correlated with hemoglobin concentration. Serum iron and total iron binding capacity were strongly correlated with microcytes and mean corpuscular hemoglobin concentration. AFM revealed a notable presence of disrupted membrane topology and roughness in IDA patients. Redox balance assessed by ferric reducing antioxidant power of plasma and intracellular ROS levels was significantly impaired. IDA erythrocytes also showed increased intracellular Ca²⁺ and phosphatidyl serine externalization.

Patients with IDA exhibited not only significant hematologic impairment but also morphologically altered erythrocytes and redox imbalance, which could promote eryptosis.