Abnormalities in erythrocyte morphology

# Differential Diagnosis of Abnormalities in Erythrocyte Morphology

## Acanthocytes (spur cells)
- Abetalipoproteinemia
- Acanthocytosis
- Cirrhosis
- Hemolytic anemia
- Hepatic necrosis
- Infantile pyknocytosis
- Pyruvate kinase deficiency
- Uremia

## Anisocytosis (variation in size), Poikilocytosis (irregular shape)
- Elliptocytosis
- Folic acid deficiency
- Iron deficiency anemia
- Infectious anemia
- Myelopathy
- Paroxysmal nocturnal hemoglobinuria
- Pernicious anemia
- Sideroblastic anemia
- Spherocytosis
- Thalassemia
- Tumor related anemia

## Basophilic Stippling
- Arsenic Poisoning
- Hemolytic anemia
- Lead poisoning
- Pyrimidine 5'-nucleotidase deficiency
- Severe anemia
- Sideroblastic anemia
- Thalassemia
- Unstable hemoglobin

## Cabot's Ring Bodies
- Hemolytic anemia
- Lead poisoning
- Pernicious anemia

## Codocytes (target cells)
- Hemoglobin C Disease
- Hemolytic anemia
- Iron deficiency anemia
- Liver disease
- Post splenectomy
- Sickle Cell Anemia
- Thalassemia minor

## Dacrocytes (teardrop)
- Extramedullary hemopoiesis
- Myelofibrosis
- Polycythemia Vera
- Severe hemolytic anemia
- Thalassemia

## Elliptocytes
- Hereditary elliptocytosis
- Iron deficiency anemia
- Megaloblastic anemia
- Microcytic anemia
- Myelofibrosis
- Refractory normoblastic anemia
- Thalassemia

## Heinz Bodies
- Drug sensitivities
- Glucose-6-phosphate dehydrogenase deficiency
- Hereditary hemolytic anemia
- Methemoglobinemia
- Oxidant drugs
- Premature infants

## Howell-Jolly Bodies
- Asplenia
- Functional hyposplenism
- Hemolytic anemia
- Leukemia
- Megaloblastic anemia
- Pernicious anemia
- Post splenectomy
- Thalassemia

## Hypochromic Microcytes
- Hemoglobinopathy
- Iron deficiency anemia
- Sickle Cell Anemia
- Thalassemia

## Intraerythrocytic Parasites
- Babesiosis
- Bartonellosis
- Malaria

## Macrocytes
- Liver disease
- Reticulocytosis

## Schistocytes
- Disseminated Intravascular Coagulation (DIC)
- Eclampsia
- Giant hemangioma
- Hemolytic Uremic Syndrome (HUS)
- Hemolytic anemia after burns
- Macroangiopathic hemolytic anemia
- Malignant hypertension
- Mechanical hemolysis
- Metastatic carcinoma
- Microangiopathic hemolytic anemia
- Transplant rejection
- Thrombotic thrombocytopenic purpura
- Vasculitis

## Sickle Cells
- Sickle Cell Anemia

## Sideroblasts
- Nucleated erythrocytes

## Spherocytes
- Acute oxidant damage
- After severe burns
- Alcoholism
- Autoimmune hemolytic anemia
- Hemoglobin C Disease
- Hemolytic transfusion reactions
- Hereditary spherocytosis
- Severe hypophosphatemia

## Stomatocytes
- Acute alcohol intoxication
- Cardiovascular disease
- Drugs
- Hepatobiliary disease
- Hereditary
- Neoplasm

# Diseases and diagnostic tools
Blood diseases involving the red blood cells include:
- Anemias (or anaemias) are diseases characterized by low oxygen transport capacity of the blood, because of low red cell count or some abnormality of the red blood cells or the hemoglobin.
Iron deficiency anemia is the most common anemia; it occurs when the dietary intake or absorption of iron is insufficient, and hemoglobin, which contains iron, cannot be formed
Sickle-cell disease is a genetic disease that results in abnormal hemoglobin molecules. When these release their oxygen load in the tissues, they become insoluble, leading to mis-shaped red blood cells. These sickle shaped red cells are rigid and cause blood vessel blockage, pain, strokes, and other tissue damage.
Thalassemia is a genetic disease that results in the production of an abnormal ratio of hemoglobin subunits.
Spherocytosis is a genetic disease that causes a defect in the red blood cell's cytoskeleton, causing the red blood cells to be small, sphere-shaped, and fragile instead of donut-shaped and flexible.
Pernicious anemia is an autoimmune disease wherein the body lacks intrinsic factor, required to absorb vitamin B12 from food. Vitamin B12 is needed for the production of hemoglobin.
Aplastic anemia is caused by the inability of the bone marrow to produce blood cells.
Pure red cell aplasia is caused by the inability of the bone marrow to produce only red blood cells.
Hemolysis is the general term for excessive breakdown of red blood cells. It can have several causes.
- Iron deficiency anemia is the most common anemia; it occurs when the dietary intake or absorption of iron is insufficient, and hemoglobin, which contains iron, cannot be formed
- Sickle-cell disease is a genetic disease that results in abnormal hemoglobin molecules. When these release their oxygen load in the tissues, they become insoluble, leading to mis-shaped red blood cells. These sickle shaped red cells are rigid and cause blood vessel blockage, pain, strokes, and other tissue damage.
- Thalassemia is a genetic disease that results in the production of an abnormal ratio of hemoglobin subunits.
- Spherocytosis is a genetic disease that causes a defect in the red blood cell's cytoskeleton, causing the red blood cells to be small, sphere-shaped, and fragile instead of donut-shaped and flexible.
- Pernicious anemia is an autoimmune disease wherein the body lacks intrinsic factor, required to absorb vitamin B12 from food. Vitamin B12 is needed for the production of hemoglobin.
- Aplastic anemia is caused by the inability of the bone marrow to produce blood cells.
- Pure red cell aplasia is caused by the inability of the bone marrow to produce only red blood cells.
- Hemolysis is the general term for excessive breakdown of red blood cells. It can have several causes.
- The malaria parasite spends part of its life-cycle in red blood cells, feeds on their hemoglobin and then breaks them apart, causing fever. Both sickle-cell disease and thalassemia are more common in malaria areas, because these mutations convey some protection against the parasite.
- Polycythemias (or erythrocytoses) are diseases characterized by a surplus of red blood cells. The increased viscosity of the blood can cause a number of symptoms.
In polycythemia vera the increased number of red blood cells results from an abnormality in the bone marrow.
- In polycythemia vera the increased number of red blood cells results from an abnormality in the bone marrow.
- Several microangiopathic diseases, including disseminated intravascular coagulation and thrombotic microangiopathies, present with pathognomonic (diagnostic) RBC fragments called schistocytes. These pathologies generate fibrin strands that sever RBCs as they try to move past a thrombus.
- Hemolytic transfusion reaction is the destruction of donated red blood cells after a transfusion, mediated by host antibodies, often as a result of a blood type mismatch.
Several blood tests involve s, including the RBC count (the number of red blood cells per volume of blood) and the hematocrit (percentage of blood volume occupied by red blood cells). The blood type needs to be determined to prepare for a blood transfusion or an organ transplantation.