In iron deficiency anemia, which red blood cell morphology is typically seen on peripheral smear?

• A. Macrocytic red blood cells
• B. Hypochromic, microcytic red blood cells
• C. Polycythemia
• D. Hyperchromic red blood cells

Answer: (B)

Iron deficiency anemia reduces hemoglobin synthesis, so red blood cells become smaller and contain less hemoglobin. On a peripheral smear this shows up as microcytosis (smaller than normal cells) and hypochromia (paler cells with increased central pallor). The combination of decreased cell size and reduced hemoglobin content is the hallmark morphology. Macrocytic cells would point to B12/folate deficiency, polycythemia would mean too many cells, and hyperchromic cells aren’t typical in iron deficiency.