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

  • Mahdieh Rajabi-Moghaddam ORCID Department of Pathology, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
  • Hamid Abbaszadeh ORCID Mail Department of Pathology, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
  • Maryam Mosaffa ORCID Student Research Committee, Babol University of Medical Sciences, Babol, Iran.
  • Hemmat Gholinia ORCID Institute of Health, Babol University of Medical Sciences, Babol, Iran
  • Shima Nafarzadeh ORCID Department of Oral and Maxillofacial Pathology, School of Dentistry, Babol University of Medical Sciences, Babol, Iran
Cytology, Iron deficiency anemia, Iran


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.



1.Sumanthi J, Reddy GS, Anuradha C, Sekhar PC, Prasad LK, Reddy BR. A study on cytomorphometric analysis of exfoliative buccal cells in iron deficiency anemic patients. Contemp Clin Dent. 2012;3(Suppl 2):S156-9.
2.Scott J, Valentine J, St Hill C, West C. Morphometric analysis of atrophic changes in human lingual epithelium in iron deficiency anaemia. J Clin Pathol.1985;38(9):1025-9.
3. Neville BW, Daam DD, Allen CM, Chi AC. Oral and maxillofacial pathology.4th ed. Missouri: Saunders co; 2016. p.377, 773.
4.Kohli M, Ahuja P, Mehendiratta M, Sharma M, Dutta J. Micronucleus Assay: An early diagnostic tool to assess genotoxic changes in patients with tobacco use, oral leukoplakia and oral submucous fibrosis. J Clinic Diagn Res. 2017;11(9): ZC28.
5. Macleod RI, Hamilton PJ, Soames JV. Quantitative exfoliative oral cytology in iron-deficiency and megaloblastic anemia. Anal Quant Cytol Histol. 1988;10(3):176-80.
6. Gururaj N, Sivapathasundharam B, Sumathy N. Cytological findings in iron deficiency anemia. Indian JDentRes. 2004;15(4):126-8.
7.World Health Organization. Iron deficiency anaemia: assessment, prevention and control: a guide for programme managers..1st ed. Geneva: WHO; 2001.
8.Sharbatdaran M, Abbaszadeh H, Siadati S, Ranaee M, Hajian‐Tilaki K, Rajabi‐Moghaddam M. Assessment of oral cytological features in smokers and nonsmokers after application of toluidine blue. Diagn Cytopathol. 2017;45(6):513-9.
9. Paraizo J, Rech I, Azevedo-Alanis L, Pianovski M, De Lima A, Machado M. Cytomorphometric and cytomorphologic analysis of oral mucosa in children with sickle cell anemia. J Cytol. 2013;30(2):104.
How to Cite
Rajabi-Moghaddam M, Abbaszadeh H, Mosaffa M, Gholinia H, Nafarzadeh S. Cytomorphometric Analysis of Buccal Exfoliated Cells in Patients With Iron Deficiency Anemia. Acta Med Iran. 58(9):424-429.