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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Ontology: Acanthocytes (C0000886)

Definition (NCI) Erythrocytes with protoplasmic projections giving the cell a thorny appearance. (MeSH)
Definition (MSH) Erythrocytes with protoplasmic projections giving the cell a thorny appearance.
Concepts Cell (T025)
MSH D000050
SnomedCT 259685005, 250250008, 63599005
LNC LP17674-0, MTHU024320, LA11190-8
English Acanthocytes, cells spur, acanthocyte, acanthocytes, acanthrocyte, spur cell, Acanthocyte (morphologic abnormality), Spur cell (finding), Acanthocyte, Acanthrocyte, Crenated cell, Spur cell, Acanthocyte (cell), Spiny prickle cell, Acanthocyte [dup] (morphologic abnormality)
French Érythrocytes en anneaux, Acanthocytes, Acanthocyte
Swedish Akantocyter
Czech akantocyty
Finnish Piikkisolut
Russian AKANTOTSITY, АКАНТОЦИТЫ
Latvian Akantocīti
Polish Akantocyty
Norwegian Akantocytter
Spanish acantocito [dup], acantocito (hallazgo), acantocito [dup] (anomalía morfológica), acantocito (anomalía morfológica), acantocito (célula), acantocito, Acantocitos
German Akanthozyten
Italian Acantociti
Dutch Acanthocyt, Acanthocyten
Portuguese Acantócitos
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Spherocytes (C0037888)

Definition (NCI) Small, abnormal spherical red blood cells with more than the normal amount of hemoglobin. (MeSH)
Definition (MSH) Small, abnormal spherical red blood cells with more than the normal amount of hemoglobin.
Concepts Cell (T025)
MSH D013102
SnomedCT 17235000, 259682008
LNC LP17717-7, MTHU024361, LA11212-0
French Sphérocytes, Sphérocyte
Swedish Sfärocyter
Czech sférocyty
Finnish Pallopunasolut
Russian SFEROTSITY, СФЕРОЦИТЫ
English Spherocytes, spherocytes, spherocyte, Spherocyte, Spherocyte (cell), Spherocyte (morphologic abnormality)
Latvian Sferocīti
Polish Sferocyty
Norwegian Sfærocytter
Spanish esferocito (anomalía morfológica), esferocito (célula), esferocito, Esferocitos
German Kugelzellen, Sphärozyten
Italian Sferociti
Dutch Kogelcel, Sferocyt, Sferocyten
Portuguese Esferócitos
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Dacryocyte (cell) (C0221266)

Concepts Cell (T025)
SnomedCT 47787007
LNC LP17677-3, MTHU024321
English Dacryocyte (cell), teardrop cells, tear drop cell, tear drop cells, dacrocytosis, teardrop cell, Dacryocytes, Tear drop cell, Dacryocyte, Teardrop cell, Dacryocyte (morphologic abnormality)
Spanish lacrimocitos, células lagrimales, eritrocito con forma de lágrima, dacriocito (anomalía morfológica), dacriocito (célula), dacriocito
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Elliptocyte (cell) (C0221280)

Concepts Cell (T025)
SnomedCT 45028007, 57882002
LNC LP17644-3, LP15192-5, LP14573-7, MTHU002587, MTHU001593, MTHU024229, LA11204-7, LA11199-9, LA11198-1
English Elliptocyte (cell), pencil cell, elliptocyte, ovalocytes, elliptocytes, pencil cells, ovalocyte, Elliptocytes, Pencil cells, Ovalocytes, Elliptocyte, Ovalocyte, Pencil cell, Pencil cell (cell), Elliptocyte (morphologic abnormality), Pencil cell (morphologic abnormality)
Spanish célula en lápiz (anomalía morfológica), célula en lápiz (célula), célula en lápiz, eliptocito (anomalía morfológica), eliptocito (célula), eliptocito, ovalocito
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Schistocyte (C0221282)

Concepts Cell (T025)
SnomedCT 142889005, 250245002, 142887007, 165480001, 70310009
LNC LP17715-1, LP14570-3, MTHU001590, MTHU017716, LA11209-6, LA11202-1
English Schistocyte, Schistocytes, cells fragmenting, helmet cells, schistocytes, schistocytosis, cells fragmented, helmet cell, schistocyte, Schistocytosis (finding), Helmet cell (finding), Schistocytosis, Helmet cells, Fragmented cell, Helmet cell, Schistocyte (cell), Schistocyte (morphologic abnormality)
Spanish eritrocitos con forma de yelmo, eritrocitos con forma de yelmo (hallazgo), célula en casco, célula fragmentada, esquistocito (anomalía morfológica), esquistocito (célula), esquistocitosis, esquistocito
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Sideroblast (C0229630)

Concepts Cell (T025)
SnomedCT 53838007
English sideroblast, sideroblasts, Sideroblast (cell), Sideroblast (body structure), Sideroblast
Spanish sideroblasto (célula), sideroblasto
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Macrocytic erythrocyte (C0333805)

Definition (NCI) An abnormally large red blood cell occurring mainly in anemias (as pernicious anemia), also called megalocyte. Lack of vitamin B12 and folic acid could also cause macrocytes. (NCI)
Concepts Cell (T025)
SnomedCT 259681001, 57457008
LNC LP17441-4, MTHU005229, LA11216-1
Spanish macrocito, eritrocito macrocítico (célula), eritrocito macrocítico, macrocito (anomalía morfológica)
English megalocytes, megalocyte, macrocytes, macrocyte, Macrocyte, Macrocytic erythrocyte (cell), Macrocyte (morphologic abnormality), Macrocytic erythrocyte, Macrocytes, Macrocytic Red Blood Cell
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Microcytic erythrocyte (cell) (C0369668)

Concepts Cell (T025)
SnomedCT 57457008, 397022008
LNC LP17463-8, MTHU005230, LA11218-7
English Microcytic erythrocyte (cell), microcyte, erythrocytes microcytic, microcytes, Microcyte (morphologic abnormality), Microcytes, Microcyte, Microcytic erythrocyte, Microcytic Red Blood Cell
Spanish microcito, microcito (anomalía morfológica), eritrocito microcítico (célula), eritrocito microcítico
Derived from the NIH UMLS (Unified Medical Language System)

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