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Appearance Cell Type Cause Pathology RBC parameters

Bell shape Target Cell Excess cholesterol Thalassemia MCHC: Normal to


and phospholipid Liver disease decreased
expand red blood Iron deficiency anemia MCV: Normal to
cell membrane. Post-splenectomy decreased
Hemoglobinopathies
Hemoglobin C disease hemoglobin C trait.
No central pallor. Spherocytes Deficiency in the Can be hereditary or acquired. MCHC is increased.
Intense colour and smaller size. membrane proteins Immune hemolytic anemia MCHC is greater than
Shape change is irreversible and may Hereditary spherocytosis 36%.
also be seen as microspherocytes Post-transfusion MCV can be decreased.
Burn patients. Reduced surface to
volume ratio.

Not biconcave. Stomatocytes Membrane defect. Acquired/Congenital. MCV usually normal.


Mouth-like central pallor. Abnormalities in Hereditary Stomatocytosis MCH and MCHC don’
In wet preparations, they appear red cell cation Rh deficiency syndrome. t change.
bowl-shaped. permeability that Hemolytic anemia.
leads to change in Alcoholic cirrhosis.
red cell volume Acute alcoholism.
which may be
hydrocytosis or
exocytosis.
Egg-shaped. Ovalocytes mechanical Acquired/Congenital. Normal to decreased
weakness or Myelophthistic anemia/sydrome. MCHC
fragility of the Thalassemic syndromes. Normal to increased
membrane skeleton Megaloblastic anemia MCV
Microcytic/hypochromic anemia.

Pencil, rod, cigar-shaped. Elliptocytes mechanical Acquired/Congenital. Normal to increased


Hemoglobin concentrated at the end. weakness or Iron deficiency anemia. MCV
Not hypochromic. normal central fragility of the Hereditary elliptocytosis.
pallor. membrane skeleton Idiopathic myelofibrosis.
Microcytic/hypochromic anemia.

Reversible: oat cell-shaped Sickle Cells Mutations in People with this disorder have atypical N/A
Irreversible: Crescent shaped with the HBB gene hemoglobin molecules called hemoglobin S
pointed projections at one or both cause sickle cell
ends. disease.

split, cut, or cloven cells Fragmented Cells- trauma to the cell microangiopathic hemolytic anemia N/A
Schistocytes membrane. disseminated intravascular coagulation (DIC)
heart valve surgery
hemolytic uremic syndrome
thrombotic thrombocytopenic purpura
renal graft rejection, vasculitis
severe burn
march hemoglobinuria (a form of
hemoglobinuria seen in soldiers and long-
distance runners).
blister cells. pocket-book Fragmented Cells- Keratocytes are red disseminated intravascular coagulation (DIC) N/A
cells. “horned” cells Keratocytes cells that have been
(keras=horn) caught on fibrin
strands in
circulation, and
rather than
splitting, the cell
hangs over the
fibrin fusing two
sides of the cell
together, creating a
vacuole.

distinctive projections, usually two, Fragmented Cells- Fragmentation Hematological conditions.


surrounding an empty area of the red Helmet cell occurs by the Pulmonary emboli. N/A
cell membrane. pitting mechanism myeloid metaplasia.
of the spleen. DIC.
G6PD deficiency.
“True burr cells” occur in small Burr cells Excess EDTA Uremia Normal MCV
numbers and appear irregularly sized (underfilled Heart disease Normal MCHC
with unevenly spaced spicules. collection tube), but Cancer of the stomach
In the case of artifact burr cells, they may also be caused Bleeding peptic ulcer
will appear in large numbers and will by slow drying, Injection of heparin,
present with evenly dispersed smooth drying in a humid Untreated hypothyroidism.
projections and may be referred to as environment, or an Artifact-specimen contamitation
crenated. alkaline pH from
glass slides.

Cells with 3-12 spicules of uneven Acanthocytes N/A myeloproliferative disorders Decreased MCV
length distributed along the periphery microangiopathic Normal MCHC
of the cell membrane. hemolytic anemia (MAHA) Increase MCV
The uneven projections are blunt. autoimmune hemolytic anemias.
Alcohol intoxication (Zieve’s syndrome)
Pyruvate kinase deficiency
Congenital abetalipoproteinemia
Vitamin E deficiency
Postsplenectomy
Tear-shaped Teardrop Cells As cells containing thalassemia syndromes Decreased, normal,
large inclusions drug-induced Heinz body formation increased MCV
attempt to pass iron deficiency
through the in conditions in which inclusion bodies are
microcirculation, formed
the portion of the megaloblastic processes as large tear-shaped
cells containing the cells (macroteardrops).
inclusion cannot Myelophthisic anemia
pass through and
consequently gets
pinched, leaving a
tailed end.

Stacks of coins Rouleaux Elevated globulins Hyperpoteinemias: multiple myeloma and N/A
Formation or fibrinogen in the Waldenstrom’s macroglobulinemia.
plasma. Chronic inflammatory disorders
Lymphomas
Artifact
Random clusters RBC Antigen-antibody Cold antibody syndromes: cold MCHC: falsely elevated
agglutionation reaction. hemagglutination disease and paroxysmal cold MCV: falsely elevated
Auto agglutination: hemoglobinuria (PCH)
patient’s own Hemolytic anemia
cells react with Atypical pneumonia
serum or plasma. Staphylococcal infections
Trypanosomiasis
Artifact

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