Poikilocytosis Review Table

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Poikilocytosis Review Table

Cell TypeImageCellular DescriptionAssociated Diseases and Conditions
Teardrop cell
  • Red blood cells (RBCs) are shaped like a teardrop with a projection extending from one end.
  • Myelofibrosis with myeloid metaplasia (MMM)
  • RBCs smaller than normal
  • No central pallor
  • Round rather than disc-shaped
  • Hereditary spherocytosis
  • Certain hemolytic anemias (eg, autoimmune hemolytic anemia)
  • Severe burns
Target cell
  • RBCs with characteristic bull's-eye morphology due to hemoglobin distribution
  • Hemoglobinopathies (e.g., sickle cell disease)
  • Certain thalassemias
  • Iron deficiency anemia
  • Splenectomy
  • Severe liver disease
Sickle cell
  • RBCs contain hemoglobin S.
  • Thorn or crescent-shaped
  • Sickle cell anemia
  • RBCs with thin, elongated area of central pallor (slit-like, or coffee-bean-shaped on peripheral blood smears)
  • Three-dimensionally, RBCs are cup-shaped.
  • Hereditary stomatocytosis
  • Alcohol-related disease
  • Liver disease
  • Rh null phenotype
  • Artifact
Schistocyte (fragmented red cells)
  • RBC blood cell fragments or pieces
  • Vary widely in size and shape
  • Severe burns
  • Hemolytic uremic syndrome (HUS)
  • Microangiopathic hemolytic anemia (MAHA)
  • Disseminated intravascular coagulation (DIC)
  • Thrombotic thrombocytopenic purpura (TTP)
Ovalocyte (elliptocyte)
  • RBCs are elongated-oval, cigar, or pencil-shaped.
  • Hereditary elliptocytosis
  • Megaloblastic anemia
  • Myelophthisic anemia
  • Certain thalassemias
  • Severe iron deficiency
Acanthocyte (Spur cell)
  • RBCs demonstrating irregularly-spaced, spiny projections that vary in size and number
  • No central pallor
  • Abetalipoproteinemia
  • Severe hepatic disease
  • Myeloproliferative disorders
  • MAHA
  • Neuroacanthocytosis
  • syndromes
Echinocyte (Burr cell)
  • RBCs have short and evenly-spaced, rounded projections surrounding the cell.
  • Central pallor present
  • Uremia
  • Heart disease
  • Pyruvate kinase deficiency
  • Stomach cancers
  • Bleeding peptic ulcers
Bite cell
  • Red cells that appear to have bites taken out of them (Image A)
  • Supravital stain reveals the presence of Heinz bodies--precipitated denatured masses of hemoglobin (Image B).
Disorders associated with Heinz body formation:
  • Unstable hemoglobins
  • Chemical poisoning
  • G-6PD
  • Hemolytic anemia associated with severe alcoholic liver disease