Hypersegmentation of neutrophils in young women with Iron deficiency

A hematological finding in cobalamin and folic acid deficiency is increased neutrophil lobulation (hypersegmentation). There are contradictory reports about correlation of neutrophil hypersegmentation (NH) to iron deficiency in recent studies. This study re-examines the relationship between both iron deficiency (ID) and iron deficiency anemia (IDA) to hypersegmentation. The effect of folate deficiency was also investigated. Due to the high prevalence of iron deficiency in young Iranian women, the study groups were selected among young women. 90 subjects, 30-16 years of age, admitted to the Clinical Laboratory of Imam Reza Hospital, Mashhad (29 subjects with ID, 30 with IDA and 31 controls) were studied. Ferritin, folate and cobalamin levels in serum were measured by RIA (Kavos-hyar reagent). Iron and Total Iron Binding Capacity (TIBC) were measured using Colorimetric methods. CBC and RBC Indexes were measured by Sysmex k-21. To investigate each patient's peripheral blood hypersegmentation, 100 neutrophils were counted separately by two experts. Chi-square test revealed significant differences among NH and three groups of ID, IDA and control group (P=0.001). NH showed significant relationships with decreased serum Ferritin and Iron (P=0.001). Logistic regression analysis showed that the relationship between NH and ID / IDA is mostly due to the simultaneous presence of low normal levels of folate deficiency (P= 0.044). This study showed a correlation between NH and iron pools and Low normal levels of Folate. Therefore, when observing NH in peripheral blood of patients, especially in women of childbearing ages, it should be suspicious of coexistence of iron and mild folate deficiency and that further investigation must be done. Because NH is a simple and low-cost testing, it could be a useful diagnostic test for screening of IDA/ID and folate deficiency especially for women of childbearing ages.