Polychromasia

What is polychromasia (polychromatophilia)?

Polychromasia (pronounced “Paa-lee-kruh-MAY-zhuh”) describes a variation in color of red blood cells on a peripheral blood smear (PBS). A PBS is a sample of your blood smeared on a glass slide that’s stained to look at under a microscope. The stain makes blood cells easier to see.

Red blood cells typically appear pink or salmon-colored on a PBS. With polychromasia, there may be several blue, bluish-gray or purple cells scattered among the pink ones. These cells are typically immature red blood cells, called reticulocytes.

Polychromasia can indicate that your bone marrow is releasing new red blood cells (reticulocytes). Bone marrow is the spongy tissue inside your large bones as adults that produces blood cells.

Why do red blood cells appear blue on a PBS?

Red blood cells appear blue because reticulocytes stain that color on a PBS. Specifically, the genetic material called RNA inside the reticulocyte appears blue or bluish-gray. RNA disappears by the time a reticulocyte develops into a mature red blood cell.

Identifying reticulocytes on a PBS is important because reticulocytes aren’t as efficient as mature red blood cells at performing their primary function — carrying oxygen to your body’s cells.

What causes polychromasia?

Polychromasia may signal an underlying condition that causes your bone marrow to prematurely release red blood cells into your bloodstream. This can happen if red blood cell levels drop. Your body compensates for low levels of mature red blood cells in your bloodstream by releasing reticulocytes from your bone marrow into your bloodstream.

Polychromasia may signal any of the following:

• Hemolytic anemia: A blood disorder that occurs when your red blood cells are destroyed prematurely. This can happen at a faster rate than your body can replace them, leading to anemia. Inherited conditions, including paroxysmal nocturnal hemoglobinuria (PNH), thalassemia and sickle cell disease can cause hemolytic anemia. Infections and certain medicines are also possible causes.
• Severe blood loss: Extreme internal or external bleeding can cause your bone marrow to ramp up red blood cell production and release reticulocytes to compensate for the loss of red blood cells in your bloodstream.
• Cancer: Certain cancers can invade your bone marrow and interfere in red blood cell production or force premature blood cells out into your bloodstream.
• Pregnancy: It’s common to have more reticulocytes in your bloodstream during pregnancy. It usually isn’t cause for concern.
• High altitudes: Oxygen levels are lower in high-altitude environments. Your body may make up for the deficiency by ramping up red blood cell production and releasing reticulocytes into your bloodstream.

Nutrients that increase RBC

Polychromasia may show up in your bloodwork once you start taking vitamins and supplements your body needs to make healthy red blood cells. Your healthcare provider may recommend these nutrients if you’re not getting enough in your diet:

• Vitamin B12.
• Folic acid.
• Iron.

What are the symptoms of polychromasia?

There aren’t any specific symptoms due to polychromasia. But you may experience symptoms of anemia.

The most common symptoms of anemia include:

• Pale skin.
• Headache.
• Weakness or fatigue.
• Shortness of breath (dyspnea).
• Fast heartbeat (tachycardia).
• Dizziness or lightheadedness.
• Low blood pressure (hypotension).
• Yellowing of your skin or the whites of your eyes (jaundice).
• Enlarged spleen (splenomegaly) or liver (hepatomegaly).

Or you may not experience any symptoms at all. It all depends on the underlying condition that’s causing polychromasia and its severity.

How is polychromasia diagnosed?

Healthcare providers can tell if you have polychromasia based on PBS results. You’ll have red blood cells that stain dark blue or blue-gray and red blood cells that stain the usual pink, indicating mature red blood cells.

As polychromasia is a finding on a blood test and not an actual diagnosis, your healthcare provider may perform additional tests to identify the underlying cause. They’ll ask about your symptoms and medical history, including what medicines you’re taking. They may do a physical exam and check for signs of hemolytic anemia, like an enlarged spleen or liver.

The specific tests you receive depend on what’s likely causing your bone marrow to release reticulocytes.

How is polychromasia treated?

Treatment is based on the cause. You may not need treatment if the cause is mild anemia and you’re not experiencing symptoms. Your healthcare provider can recommend treatments if you have a serious underlying condition that’s causing polychromasia.

Treatments may include:

• Blood transfusion,for certain inherited conditions, like sickle cell disease, or severe blood loss.
• Corticosteroids, if you have a condition that’s causing your immune system to destroy your red blood cells, as in autoimmune hemolytic anemia.
• Immunosuppressants, if you have a condition that’s causing your immune system to destroy your red blood cells, and treatments like corticosteroids aren’t working.

You may need specific medications to target a bacteria, virus or parasite if an infection is causing polychromasia. You may need to stop taking certain medications or switch medications if a drug is the underlying cause. Your healthcare provider can guide you on how to switch or stop taking medications safely. You shouldn’t stop taking a medication without first talking to your provider.

Should I be worried about polychromasia?

Not necessarily. Polychromasia may be a sign of a blood disorder that requires treatment, or it may not be an issue at all.

Your healthcare provider will let you know if these results are concerning or if you’ll need additional tests.

When should I see my healthcare provider?

Schedule a visit with a healthcare provider if you’re experiencing symptoms of hemolytic anemia, like fatigue, paleness or shortness of breath. In the meantime, don’t skip annual check-ups. Your healthcare provider can check your blood cells, using tests like a PBS if necessary.

Bloodwork results provide information about your general health, and they can alert your provider of potential blood disorders that require treatment.

A note from Cleveland Clinic

It may be startling to see a word like “polychromasia” on your blood test results, but don’t be alarmed if you do. Polychromasia is a description, not a diagnosis. It just means that you have more immature red blood cells in your bloodstream than what’s considered normal. It may signal an underlying condition, or it may be a harmless, temporary finding. Talk to your healthcare provider if you’re concerned. They can explain what this result means for you.