3 March - Anemia in the elderly

After finding out this morning that morning report is illegal in Tennessee, we discussed a hypothetical case of anemia in elderly patients.  One of the features that suggests MDS is an isolated normo or macrocytic anemia.  Other features include poikolocytosis, dacrocytosis, and anisocytosis.  Pseudo Pelger-Huet cells are an indicator of MDS.  Teardrop shaped cells, as I have been told in the past, mean "the bone marrow is crying."  Below is an image of a pseudo Pelger-Huet cell.

Also, our own Dr Lands has published this article on anemia in elderly patients.  Appropriate to today's discussion, anemia has been strongly and independently linked to cognitive decline in the elderly.  I have a PDF which is easier to read if anyone wants a copy.

Pseudo - Pelger-Huet cell - link to ASH image database

Dacrocytes, or tear drop poikilocytes, links to ASH image bank

In contrast to pseudo-Pelger-Huet cells which generally signify internal disease, true Pelger-Huet anomaly is an essentially benign condition that comes to attention whem automated WBC counts suggest bandemia or immature WBC forms / left shift.  This emedicine article discusses this condition in more detail.