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Red Blood Cell Morphologic Changes in Hemolytic Anemias

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RBC Morphology	Causes
Acanthocytes (spur cells)	Abetalipoproteinemia Anorexia Hypothyroidism Liver disease Neuroacanthocytosis
Agglutinated cells	Cold agglutinin disease
Echinocytes	Glycolytic pathway defects Liver dysfunction Renal dysfunction
Heinz bodies (bite or blister cells)	Glucose-6-phosphate dehydrogenase (G6PD) deficiency Oxidant stress Unstable hemoglobin
Nucleated erythroblasts and basophilic stippling	Thalassemia major
Schistocytes	Microangiopathic hemolytic anemia (MAHA), including disseminated intravascular coagulation (DIC) and thrombotic microangiopathy (TMA) Valve hemolysis, Intravascular prostheses, and extracorporeal devices Vitamin B12 deficiency (pseudo-thrombotic thrombocytopenic purpura [pseudo-TTP])
Sickle cells	Sickle cell disease
Spherocytes	Hereditary spherocytosis Transfused blood Warm antibody hemolytic anemia
Target cells	Hemoglobinopathies (eg, sickle cell disease, hemoglobin C disease, thalassemias) Liver dysfunction Post-splenectomy