Erythrocyte Morphology on Peripheral Smear

Aka: Erythrocyte Morphology on Peripheral Smear, Erythrocyte Morphology, Red Blood Cell Morphology, Macrocyte, Microcyte, Spherocyte, Elliptocyte, Schistocyte, Acanthocyte, Spur Cell, Dacryocyte, Howell-Jolly, Target Cell, Basophilic Stippling, Sideroblast, Cabot's Ring Bodies

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II. Background

  1. Variants below as seen on Peripheral Smear
  2. RBC Evaluation parameters
    1. RBC Color
    2. RBC Size
    3. RBC Shape
    4. RBC Contents

III. Causes: Macrocytes

  1. See Macrocytic Anemia
  2. Reticulocytosis
  3. Liver disease

IV. Causes: Hypochromic Microcytes: Defective Hemoglobin synthesis

  1. See Microcytic Anemia
  2. Iron Deficiency Anemia
  3. Thalassemia
  4. Sickle Cell Anemia
  5. Hemoglobinopathy

V. Causes: Spherocytes

  1. Hereditary Spherocytosis
  2. Autoimmune Hemolytic Anemia
  3. Acute Alcoholism
  4. Hemoglobin C Disease
  5. Following severe Burn Injury
  6. Hemolytic Transfusion Reactions
  7. Severe Hypophosphatemia
  8. Acute Oxidant Injury: Hexose Monophosphate Shunt Defect
  9. Clostridium Welchii Septicemia

VI. Causes: Elliptocytes (Oval Cells)

  1. Megaloblastic Anemia
  2. Myelofibrosis
  3. Refractory normoblastic Anemia
  4. Hereditary elliptocytosis
  5. Thalassemia

VII. Causes: Schistocytes (Fragmented Red Blood Cells)

  1. Microangiopathic Hemolytic Anemia
    1. Disseminated Intravascular Coagulation (DIC)
    2. Thrombotic Thrombocytopenic Purpura (TTP)
    3. Hemolytic Uremic Syndrome (HUS)
    4. Giant Hemangioma
    5. Metastatic Carcinoma
    6. Malignant Hypertension
    7. Eclampsia (Toxemia of Pregnancy)
    8. Vasculitis
  2. Macroangiopathic Hemolytic Anemia
    1. Prosthetic Heart Valve

VIII. Causes: Dacryocytes (tear drop RBC)

  1. Extramedullary hemopoiesis
  2. Myelophthisic Anemia
  3. Severe Hemolytic Anemia
  4. Erythroleukemia

IX. Causes: Acanthocytes (Spur Cells)

  1. Abetalipoproteinemia
  2. Cirrhosis
  3. Hepatic necrosis
  4. Pyruvate kinase deficiency
  5. Uremia
  6. Infantile pyknocytosis

X. Causes: Howell-Jolly Bodies

  1. Postsplenectomy
  2. Megaloblastic Anemia

XI. Causes: Basophilic Stippling (aggregated ribosomes)

  1. Lead Poisoning
  2. Arsenic Poisoning
  3. Thalassemia
  4. Sideroblastic Anemia
  5. Hemolytic Anemia
  6. Severe Anemia
  7. Unstable Hemoglobin
  8. Pyrimidine 5'-Nucleotidase Deficiency

XII. Causes: Heinz Body (Aggregates of denatured Hemoglobin)

  1. Oxidative Hemolytic Anemia (G6PD Deficiency)

XIII. Causes: Target Cells

  1. Thalassemia
  2. Hemoglobin C
  3. Hemoglobin S (Sickle Cell Anemia)
  4. Liver Disease

XIV. Causes: Sideroblasts

  1. See Sideroblastic Anemia
  2. Nucleated RBCs
  3. Iron laden mitochondria

XV. Causes: Cabot's Ring Bodies (Nuclear remnants)

  1. Lead Toxicity
  2. Pernicious Anemia
  3. Hemolytic Anemia

XVI. Causes: Other findings on RBC exam

  1. Malaria
  2. Bartonella Parasites

XVII. References

  1. Ravel (1995) Clinical Laboratory Medicine, p. 14-16

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