Table 6.

Association of Erythrocyte Morphology with Clinical Conditions

Pathologic conditions can cause red blood cells to exhibit morphologic changes in size, shape, and
hemoglobin content. Although a few changes may be considered nonspecific, many morphologic changes in
red blood cells can be linked to specific disease states. These include:

Abnormalities in Red Cell Size:

Type of Size
Image Clinical Correlations
Abnormality
Macrocytes • Megaloblastic anemias (B12/ folate deficency-- may see
macro ovalocytes)
• Liver disease
• Myeloproliferative disease
• Myelodysplasia
• Post splenectomy
• Aplastic anemia

Microcytes • Iron deficiency anemia

• Thalassemia
• Lead poisoning
• Sideroblastic anemia

Note: Iron deficiency is the most common cause of microcytic

anemia

Abnormalities in Erythrocyte Shape:

Type of Shape Abnormality Image Clinical Correlations
Acanthocyte (spur or thorn • Alcoholic liver disease
cell) • Abetalipoproteinemia
• Disorders of lipid metabolism
• Post splenectomy

Bite cell • Hemolytic anemias involving denatured

hemoglobin such as G6PD deficiency

Echinocyte (Burr cell, • Uremia / renal disease

crenated cell) • Liver disease
• Pyruvate kinase deficiency
• Peptic ulcer
• Gastric carcinomas
• Artifact (crenated cells)

Page 1 of 3, revised January 1, 2018

Table 6. Association of Erythrocyte Morphology with Clinical Conditions

Type of Shape Abnormality Image Clinical Correlations

Fragmented red • Microangiopathic anemias
cell (schistocyte, helmet o Hemolytic uremic syndrome (HUS)
cell, keratocyte) o Thrombotic thrombocytopenic purpura
(TTP)
o Disseminated intravascular coagulation
(DIC)
• Severe burns

Ovalocyte (elliptocyte) • Hereditary ovalocytosis

• Megaloblastic anemia (macro ovalocytes)
• Thalassemia
• Severe iron deficiency
• Sickle cell anemia

Sickle Cell (drepanocyte) • Sickling disorders (sickle cell anemia, hemoglobin

SC disease, sickle/thalassemia)

Spherocyte • Hereditary spherocytosis

• Autoimmune hemolytic anemia
• Microangiopathic anemias
• Hereditary stomatocytosis
• Severe burns

Stomatocyte (hydrocyte) • Hereditary stomatocytosis

• Alcoholic liver disease
• Spherocytosis
• Lead poisoning
• Neoplasms
• Cardiovascular disease
• Artifacts

Target cell (codocyte) • Hemoglobinopathies

• Thalassemias
• Liver disease
• Renal disease
• Iron deficiency
• Post splenectomy

Teardrop (dacrocyte) • Thalassemias

• Myelophthisic anemia
• Megaloblastic anemia
• Myelofibrosis

Page 2 of 3, revised January 1, 2018

Table 6. Association of Erythrocyte Morphology with Clinical Conditions

Abnormalities in Erythrocyte Color:

Type of Color Abnormality Image Clinical Correlations
Hypochromia • Iron deficiency
• Thalassemia
• Anemia of chronic disease

Polychromatophilia (diffuse • Microangiopathic anemias

basophilia) • Rapid erythrocyte regeneration
• Newborns
• Acute blood loss

Abnormalities in Erythrocyte Arrangement:

Type of Arrangement
Image Clinical Correlations
Abnormality
Agglutination • Reactions of erythrocyte antigens with IgM antibodies,
ie, cold agglutinins

Rouleaux • Monoclonal gammopathies, eg, multiple myeloma

Page 3 of 3, revised January 1, 2018