Acanthocytes are densely stained, spheroidal red blood cells that lack central pallor and have 3-20 irregularly distributed, thorn-like projections of variable size/length/thickness, often with drumstick (knobby) ends. Spicules may occasionally have branches. Typically seen in cirrhosis, but also in hereditary abetalipoproteinemia and related neurological syndromes. Small numbers may be observed post-splenectomy.