Acanthocytosis

Excerpt

The membrane of red blood cells (RBCs) can undergo a variety of changes leading to morphologic alterations in these cells. When viewed under a freshly prepared peripheral blood smear (PBS), acanthocytes appear as cells with a few spicules of different sizes, projecting from the surface of the RBC membrane at irregular intervals. They result from alterations in membrane lipids and proteins and occur in patients with severe liver dysfunction, neuroacanthocytosis, abetalipoproteinemia, malnutrition, hypothyroidism, post-splenectomy, etc. The clinical significance of acanthocytes lies in their vulnerability to splenic trapping and destruction due to their morphology, which ultimately leads to anemia. When remodeled by the spleen in liver disease patients, acanthocytes develop more blunt spicules and become relatively more spherocytic; these are known as spheroacanthocytes or ‘spur cells.’