Detection of human erythrocytes influenced by iron deficiency anemia and thalassemia using atomic force microscopy.

Purpose: Iron deficiency anemia (IDA) and thalassemia (THAL) are two types of microcytic anemia, and both of these conditions disturb the morphology and function of erythrocytes at the molecular level. The ability to distinguish between thalassemic and iron deficiency anemia microcytosis has important clinical implications. The purpose of this study was to show that pathophysiological changes to erythrocytes could be detected at the nanometer scale, which is important for the early diagnosis of anemia and for distinguishing between IDA and THAL.

Methods: Blood samples were taken from six healthy volunteers and six patients with either iron deficiency anemia or thalassemia. Changes in the morphological of erythrocytes were studied at the nanometer level using atomic force microscopy (AFM).

Results: There were dramatic overall shape and surface membrane deformations of the erythrocytes associated with iron deficiency anemia and thalassemia compared to healthy erythrocytes. Healthy and pathological erythrocytes of iron deficiency anemia and thalassemia could be distinguished by the morphologic parameters of width, length, the ratio of length to width, valley, peak, valley-to-peak, standard deviations, and surface fluctuation. These AFM parameters of erythrocyte morphology differed greatly between iron deficiency anemia and thalassemia.

Conclusion: AFM was found to be an extremely useful tool for detecting and distinguishing between iron deficiency anemia and thalassemia. Erythrocyte morphology is an important determinant for diagnosing and distinguishing IDA and THAL.