Cytomorphometric Analysis of Buccal Exfoliated Cells in Patients With Iron Deficiency Anemia

Abstract

Iron deficiency anemia can cause histopathologic alterations in the oral mucosa. Exfoliative cytology is a cheaper and less aggressive method for early diagnosis. The aim of this study was to compare the cytological and cytomorphometric characteristics of buccal exfoliated cells of iron deficiency anemic patients with those of healthy controls. This case-control study compared a group of 40 patients with iron deficiency anemia (IDA) with an age- and gender-matched control group (C) of 40 healthy individuals. The buccal mucosal smears were stained using the Papanicolaou technique for cytological analyses. Cellular clumping, cytoplasmic diameter (CD), nuclear diameter (ND), cytoplasmic area (CA), nuclear area (NA), nucleus to cytoplasmic area ratio (NA/CA), cellular and nuclear pleomorphism, micronuclei (Mn), binucleation, bacterial colonies, and keratin flakes were evaluated using a light microscope and digital image analysis. Mean values for IDA and C groups were: bacterial colonies (1.88 and 0.65; P=0.002); CA (2209.88 and 1687.79 μm²; P=0.006); Mn (1.60 and 0.60; P=0.02). Significant increases in bacterial colonies, CA and Mn were seen for the IDA group. The number of cellular clumps, CD, ND, NA, NA/CA, cellular and nuclear pleomorphism, binucleation, and the number of keratin flakes didn’t show significant differences between studied groups (P>0.05). There wasn’t any significant difference with respect to overall atypia. This study revealed that IDA was able to induce significant changes in CA and Mn of the oral epithelial cells. Exfoliative cytology and cytomorphometry can be used as a tool to assess the mucosal changes in IDA patients.