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Red Cell Morphology
Acanthocytes
Acanthocytes are red blood cells that have between between 2 and 20 spicules that are of unequal length and distributed irregularly over the red cell surface. They are often associated with liver disease such as alcoholic cirrhosis but can also be seen in post splenectomy, abetalipoproteinaemia, Vitamin E deficiency, poor dietary intake e.g. anorexia and anorexia nervosa, neurological disease (neuroacanthocytosis) and McLeod phenotype - an X-linked recessive mutation of the Kell blood group system. Acanthocytes arise from either of two mechanisms – alterations in membrane lipids (e.g. liver impairment) or alteration on membrane structural proteins (e.g. neuroacanthocytosis)
Anisocytosis
Anisocytosis indicates that there are different sizes of red cells seen. The image shows marked anisocytosis with marked hypochromia also present. Anisocytosis is associated with a number of anaemias including iron deficiency anaemia, autoimmune haemolytic anaemia, and megaloblastic anaemia. It is important when reviewing the blood film that all the red cell parameters are reviewed together to help determine what the underlying cause is.
Anisopoikilocytosis
Anisopoikilocytosis can be useful when both anisocytosis and poikilocytosis of equal grading is present. It is useful in conditions such as Myelodysplasia, Myelofibrosis, marked B12/Folate deficiency, in thermal burns, or in rare hereditary conditions such as hereditary pyropoikilocytosis - a red cell membrane disorder that occurs due to mutations in the genes encoding α-spectrin, β-spectrin or Protein 4.1R. The resulting defects alter the horizontal cytoskeleton affecting red cell membrane stability and deformability causing a shortened RBC lifespan