Q. Why am I having severe fatigue and bone pain with abnormal findings in my blood smear?

Answered by
Dr. Parth R Goswami
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Mar 16, 2022

Hello doctor,

I have a history of breast cancer for which the treatment got completed around two years back.

Following are the current findings of my blood smear:

  1. Anisocytosis: +1,
  2. Poikilocytosis: +1,
  3. Polychromasia: +1,
  4. Ovalocytes: +1,
  5. And a few atypical lymphocytes.

I am feeling very weak with severe bone pain so I am bedbound. I am taking the Metoprolol and Losartan inhalers and tried taking the tablet Enbrel and the tablet Humira. Earlier, I had taken the tablet Norco for pain.

Last year also, I got the blood smear done. It had tear-drop cells: +1 and low lymphocytes at the lower border.

Are these findings significant?



Welcome to

Following is my opinion of your findings:

  1. Anisocytosis means variations in the size of red blood cells and poikilocytosis is variations in the shape of red blood cells. These two findings together with polychromasia could be because of hemolytic anemia. However, anemia is a matter of concern but do not worry about it.
  2. In the attached reports (attachments removed to protect the patient's identity), hemoglobin value is not given so, you can get a full CBC (complete blood count) test done to check hemoglobin value as well.
  3. Reactive lymphocytes can be seen in cases of viral infections as well.

For your bone pain, you can get your vitamin-D and calcium levels checked. You have a history of breast cancer and so the cancer spread to bone also needs to be ruled out by PET (positron emission tomography) or MRI (magnetic resonance imaging) scan.

You should follow the management plan of your doctor and discuss all these things with your oncologist.

I hope I have answered your question.

Let me know if I can assist you further.

Best regards.

Hi doctor,

My findings returned to normal levels after four days, except for the morphology of red blood cells. I think I have attached the right report now. The vitamin-D level is a bit low, around 29 ng/mL. The calcium level was 9.5 mg/dL but it has increased to 10.2 mg/dL. Pet scan was clear except for severe degenerative disc disease of the lower spine with bone marrow edema.

I am planning to see a hematologist next week. My oncologist has referred me to him. Do you think he will ask for a bone marrow biopsy or maybe he will say everything is fine? I know we will not know the answer until the appointment, but I wanted to mentally prepare myself in advance if it seems serious.

Thank you for your time and thoughtful answer.

Take care.



Welcome back to

Following is my opinion for your further queries:

  1. In the attached report (attachments removed to protect the patient's identity), hemoglobin value is normal, that is within the range so you are not having anemia.
  2. Mild variations in red blood cells size and shape can occur sometimes. You need not worry about anisocytosis and poikilocytosis. Polychromasia might be present in your case due to mild hemolysis so do not worry about the morphology of red blood cells.
  3. If your white blood cell count and platelets count is within the normal range, then you might not need a bone marrow biopsy, according to me. However, this decision has to be taken after your physical examination and review of all the reports.
  4. For low vitamin D levels, you can take the Cholecalciferol sachet 60000 IU once a week, with milk for six weeks.
  5. Your PET (positron emission tomography) scan is normal as per the history so, bone metastasis of breast cancer is also not possible.

I hope I have answered your questions.

Let me know if I can assist you further.

Best regards.

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