Red blood cell morphology in sickle cell anemia as determined by image processing analysis: the relationship to...

Red blood cell morphology was studied in the peripheral blood of adults with sickle cell anemia to determine if changes occur during painful crises. Image processing of the cells with an automated system of red blood cell analysis was used. Four groups of cells were observed: normocytes, macrocytes, target cells, and cells with the shape of irreversibly sickled cells. During asymptomatic periods, the percentages of these cells differed in each individual but were typical for that individual and generally were stable. During crises, macrocytosis occurred and the concentration of irreversibly sickled cells showed greater fluctuation. The macrocytosis most likely reflected a marrow response to increased hemolysis and demonstrated that the increased red blood cell destruction observed during pain crises may be more extensive than previously considered. Changes in the concentration of irreversibly sickled cells during crises were not consistent and could not be used as an indicator of a crisis. Image processing with automated red blood cell analysis allows for accurate assessment of all the morphologic groups of red blood cells in patients with sickle cell anemia and compares well with standard methods for measuring the concentration of irreversibly sickled cells.