SUMMARY A 23 year old woman presented with facial pain, a right parotid tumour and iron deficiency anaemia. She had several cutaneous venous swellings and tumours with a similar appearance were found in the large bowel. Histological examination of the parotid tumour and angiography of the skin and gut lesions confirmed that they were venous in origin. The aetiology, classification, and complications of disorders of the venous system and the importance of using a tourniquet to examine the peripheral veins is discussed.There is an ill defined group of conditions characterised by the coexistence of lesions in both the skin and the internal organs. For example, in blue rubber bleb naevus disease haemangiomas in the skin are associated with vascular polyps in the bowel. The latter may give rise to occult or frank gastrointestinal tract bleeding resulting in anaemia.We have recently investigated a woman who presented with anaemia and a unilateral parotid swelling. She also had unusual skin lesions which seemed to arise from veins, and we found vascular tumours with similar appearances in the large bowel. This combination of abnormalities led to the diagnosis of blue rubber bleb naevus disease. Angiography confirmed that the skin and the bowel lesions were part of the venous system. This case illustrates firstly that careful examination of the skin of patients with anaemia may reveal the cause, and secondly how detailed investigation of vascular lesions helps in classification.Case history A 23 year old shop assistant initially visited her general practitioner because of heavy menstrual bleeding. He thought she was anaemic and prescribed oral iron supplements. Three years later, in

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We observed increased numbers of an infrequently referenced poikilocyte, the prekeratocyte, in iron deficiency anemia (IDA) compared with beta-thalassemia minor and anemia of chronic disease (ACD) and, therefore, chose to quantify these cells and other morphologic features in these anemias. Prekeratocytes were observed in 31 (78%) of 40 IDAs vs 11 (37%) of 30 beta-thalassemias (P = .001) and 5 (13%) of 40 ACDs (P < .001) and averaged 0.78 per 1,000 RBCs in IDA vs 0.21 in beta-thalassemia (P < .001) and 0.075 in ACD (P < .001). Pencil cells also were more commonly seen and more numerous in IDAs than in beta-thalassemia or ACD. Target cells were present in most IDAs and thalassemia and in similar numbers. Basophilic stippling was seen in only 5 (17%) of the beta-thalassemias. Our results lend quantitative support to prekeratocytes and pencil cells as morphologic features favoring the diagnosis of IDA but fail to support the diagnostic usefulness of target cells and basophilic stippling in discriminating IDA and beta-thalassemia minor.

This review offers a birds-eye view of the state of automated hematology at the turn of the millennium. Despite its shortcomings (mainly flaggings and labor-intensive demands for confirmation), instrument-driven hematology provides much accurate and precise data to clinicians. Advances in technology over the next few decades will undoubtedly improve on the categorization of currently ambiguous mononuclear cells and even introduce channels for the detection and subclassification of poikilocytes. Until then, familiarity with the morphology of blood cell variants will be mandatory for technologists attending to the demands of flagging.

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