Erythrocyte Morphological Abnormalities and Associations with Clinical Profiles in Children Aged 0 to 5 Years, Yaoundé-Cameroon: an Analytical Study

Abstract Background Peripheral blood smears are an accessible diagnostic tool for identifying erythrocyte morphological abnormalities associated with hematological, infectious, or nutritional disorders. Despite their diagnostic value, their use remains limited in many resource-constrained settings. During early childhood, many inherited red cell disorders may present with nonspecific or absent morphological phenotypes, making genetic diagnosis challenging in low-resource settings. This study described the frequency and distribution of erythrocyte morphological abnormalities in children aged 0 to 5 years and evaluated their associations with clinical profiles. Methods A cross-sectional, analytical study was conducted from January 1 to June 30, 2025, at the Chantal Biya Foundation's Mother and Child Center. 158 children aged 0 to 60 months were enrolled. Blood smears were prepared from capillary or venous blood collected in EDTA and stained using May-Grünwald-Giemsa, according to International Council for Standardization in Haematology (ICSH) recommendations for blood smear review. Slides were blindly analyzed by three biologists. Ten consecutive immersion fields (×100) were examined per smear to identify and quantify erythrocyte morphological abnormalities. Sociodemographic, clinical, and biological data were correlated with the abnormalities using Pearson's Chi² or Fisher's exact test, with significance set at p < 0.05. Results Among the 158 children included, 78.6% (n = 125) were anemic. Shape abnormalities predominated (86.1%), notably anisopoikilocytosis (82.3%), schistocytes (44.9%), echinocytosis (42.4%), and polychromatophilia (41.1%). Three or more abnormalities were found in 63.3% of the children. The number of abnormalities was significantly associated with hemoglobin (p = 0.001), hematocrit (p = 0.003), and reticulocytes (p < 0.001). No significant association was found between the main morphological abnormalities and anemia or clinical parameters (p > 0.05). Conclusion Erythrocyte morphological abnormalities were highly prevalent in the children. Their accumulation was associated with more severe anemia and increased reticulocyte counts. Although individual abnormalities were not statistically associated with clinical profiles, specific findings such as sickle cells and target cells represent accessible and valuable diagnostic clues for underlying hemoglobinopathies and other inherited red cell disorders in resource-limited settings. Systematic blood smear examination, coupled with a stepwise diagnostic approach, can improve early recognition of both common and rarer genetic conditions when advanced testing is not immediately available.