Red blood cell hyperchromia: causes, symptoms and treatment

Carrying out a morphological examination of erythrocytes under a microscope, a hematologist notes not only their physical parameters, but also the color shade. If the color of the blood cells is saturated, it overlaps the median enlightenment, typical of normal blood cells, a condition such as hyperchromia is recorded. Her statement is a sign that a person has fully developed hyperchromic anemia, or it is in the process of formation.

 If enlarged erythrocytes are found, a diagnosis of macrocytic or megaloblastic anemia is made. To confirm it, additional methods of examination will be required.

Hyperchromia – hyperchromic anemia

A change in the color of erythrocytes due to their excessive saturation with hemoglobin fixes the color index (CP).

Hyperchromia is the leading symptom of macrocytic (megaloblastic) hyperchromic anemias:

• Macrocytosis (hyperchromic macrocytic anemia);

• Avitaminosis b12;

• Folic acid or vitamin B deficiency_9.

In these conditions, erythrocytes are represented by megaloblasts and megalocytes with a diameter of over 10 microns, while the norm is 7-8 microns.

The picture below shows red blood cells:

Hematological analysis parameters typical for patients with hyperchromic macrocytic anemia:

• Hyperchromasia (hyperchromia) – saturation of erythrocytes with chromoprotein (Hb) until the central clearing is erased;

• The appearance of macrocytes and megalocytes among blood cells;

• Fixation of schizocytosis (fragments of blood cells), anisocytosis, poikilocytosis (changes in the shape of red blood cells);

• Fixation of erythrocytes that have not lost nuclear substances;

• Reduction in the number of young forms of erythrocytes (reticulocytes) and a violation of their differentiation;

• Shift of the leukocyte formula to the left: the appearance of young blood cells and myelocytes, the absence of basophils, a decrease in the number of leukocytes;

• Changes in the platelet formula (acquisition of giant platelets against the background of a decrease in their number).

All changes are provoked by the megaloblastic type of hematopoiesis in the bone marrow. This is a common symptom of genetically determined or acquired anemia associated with impaired DNA formation.

What happens in the bone marrow?

With megaloblastic type of hematopoiesis, hyperchromic macrocytic anemia occurs.

Hematopoietic processes on the example of B12 deficiency:

• The presence in the bone marrow of high cellularity, ineffective erythropoiesis and megaloblastic hematopoiesis.

• Violation of cell division, preparing to become full-fledged erythrocytes, their transformation into megaloblasts, maturation of the nucleus and cytoplasm at different times.

• Variability in the maturation of megaloblasts, different-time maturity of cells, the appearance of such a sign as “blue” bone marrow, when erythrocytes are represented by promyeloblasts or basophils.

• Saturation of the cytoplasm of megaloblasts earlier than normal (hemoglobinization of the cytoplasm) against the background of an intact delicate nucleus.

• Formation in the nuclei of degenerative processes such as mitosis and disintegration of the cell nucleus, as a result of which they become ugly and defective, die early, barely “born”.

• The formation of megalocytes and macrocytes are signs of hyperchromic macrocytic anemia.

• The negative effect of cell division on the formation of red blood cells (ineffective erythropoiesis), although the synthesis of red pigment remains normal.

• Violations of DNA synthesis in white blood cells: changes in the size of myelocytes, young, promyelocytes and rods, mature segmented leukocytes.

Changes similar to changes that occur with B deficiency₁₂, also occur with deficiency of B₆.

Causes and symptoms of anemia

Anemia is not an independent disease, but a clinical syndrome indicating oxygen deficiency in the body. Anemia results in cardiac ischemia and heart failure.

Causes of anemic syndrome and hyperchromia:

• Avitaminosis B₁₂: deficiency of cyanocobalamin in food, impaired absorption due to helminthiasis, pancreatic pathologies, toxic poisoning, gastrointestinal diseases, hereditary predisposition.

• Folate deficiency anemia: vegetarianism, alcoholism, pregnancy status;

• Hyperchromia with megaloblastic anemia: suppression of DNA and RNA synthesis due to impaired enzyme activity.

• Hyperchromia and macrocytosis: severe liver pathologies leading to impaired synthesis of vitamins, especially vitamins B₁₂, B₆that synthesize purine and pyrimidine bases.

• Myelodysplastic syndrome, certain types of hemolytic anemia.

• Hyperchromia can appear against the background of active smoking, as the body experiences chronic hypoxia.

Private and specific symptoms of megaloblastic hyperchromic anemia:

• General: weakness, pallor, tachycardia, headache.

• Specific: burning tongue, shaky and unsteady gait.

In the triad of symptoms B₁₂– anemia includes pathologies of the blood, gastrointestinal tract, nervous system, while with a deficiency of folic acid, the nervous system does not suffer. The most commonly diagnosed combined pathology is a combination of B₁₂ and folic acid anemia.

How to treat?

There is no specific therapy for hyperchromia, the doctor treats B₁₂– folate deficiency anemia or these conditions separately. The main direction of treatment is the appointment of vitamin B supplements to the patient₉. It is important to clarify the diagnosis, since excessive use of folic acid will harm the body, exacerbate the symptoms of the disease. It is more expedient to prescribe cyanocobalamin instead of a vitamin.

Principles of therapy for beriberi B 12:

• Replenishment of cyanocobalamin deficiency;

• Active and continuous replenishment of vitamin B₁₂;

• Prevention of the development of anemia in order to avoid the development of pathology.

A mandatory measure is the fortification of the diet through the consumption of appropriate products.