Question

  This 18 year-old African-American female was in for her first prenatal visit.  She was 8 weeks pregnant. She had been in good health and gave no significant family history. The routine CBC was flagged and reflexed to manual smear differential. The medical laboratory scientist reported moderate increase of target cells, polychromasia, and rectangular crystals on her smear. Here below is part of her CBC data.    

WBC: 11.1 x 10 3 / microL

RBC: 3.82 x 10 6 / microL

Hgb: 10.9 g/dL

HCT: 32.6%

What will be the prognosis? Is there any particular care for her current pregancy?

Answer 1

WBC count is normally around 7-10 thousands. So slightly elevated numbers which is due to the pregnancy. WBC count is normally elevated during the pregnancy due to the stress on the body.

RBC count is in normal range for the first trimester. Hgb is slightly lower than it is needed in the first trimester. HCT is also in the normal range.

Polychromasia is a condition where blood has many immature RBCs. They are released prematurely in to the blood from the bone marrow. Presence of many such cells indicates an underlying defect of the blood formation in bone marrow.

Target cells are the RBCs which have more surface area than the volume. There is disproportinate increase in the RBC surface area which is due to less hemoglobin in the RBCs.

The microscopic observation where increase in target cells and polychromasia conditions are of clinical importance because these indicate that the hemoglobin levels are low and hence she needs to take special care of her diet, vitamins and also minerals such as Fe. So B complex vitamins such folic acid, vitamin B12, and minerals all required for the formation of hemoglobin are important for maintaining the levels of hemoglobin during pregnancy.