RBC Morphologies and Inclusions

Question 1

Answer 1

acanthocytes (“spur cells”)

liver disease, abetalipoproteinemia, vitamin E deficiency

Question 2

Answer 2

echinocytes (“burr cells”)

liver disease, ESRD, pyruvate kinase deficiency

Question 3

Answer 3

dacrocytes (“teardrop cells”)

bone marrow infiltration (myelofibrosis)

Question 4

Answer 4

schistocytes (“helmet cells”)

MAHAs (DIC, TTP/HUS, HELLP syndrome), mechanical hemolysis (e.g., heart valve prosthesis)

Question 5

Answer 5

degmacytes (“bite cells”)

G6PD deficiency

Question 6

Answer 6

elliptocytes

hereditary elliptocytosis

Question 7

Answer 7

spherocytes

hereditary spherocytosis, autoimmune hemolytic anemia

Question 8

Answer 8

macro-ovalocytes

megaloblastic anemia (also hypersegmented PMNs)

Question 9

Answer 9

target cells

HbC disease, asplenia, liver disease, thalassemia

Question 10

Answer 10

sickle cells

sickle cell anemia; sickling occurs with low oxygen conditions (high altitude, acidosis)

Question 11

(bone marrow)

Answer 11

iron granules

sideroblastic anemias (lead poisoning, myelodysplastic syndromes, chronic alcohol overuse)

Question 12

Answer 12

Howell-Jolly bodies (basophilic nuclear remnants that do NOT contain iron; usually removed by splenic macrophages)

functional hyposplenia (sickle cell disease), asplenia

Question 13

Answer 13

basophilic stippling (basophilic ribosomal precipitates; do NOT contain iron)

sideroblastic anemias, thalassemias

Question 14

Answer 14

Pappenheimer bodies (basophilic granules that contain iron)

sideroblastic anemia

Question 15

Answer 15

Heinz bodies (denatured and precipitated hemoglobin; phagocytic removal => bite cells)

G6PD deficiency