Which red blood cell morphology is most characteristic of immune-mediated hemolytic anemia (IMHA)?

Which red blood cell morphology is most characteristic of immune-mediated hemolytic anemia (IMHA)?

• A. Acanthocytes
• B. Spherocytes
• C. Target cells
• D. Echinocytes

Answer: (B)

In immune-mediated hemolytic anemia, red blood cells are coated by antibodies and often lose membrane material as they’re removed by the spleen. This creates small, round, dense cells that lack the central pallor—spherocytes. They’re the hallmark morphologic finding because they reflect membrane loss from the cell during immune attack and splenic clearance, which is central to IMHA’s pathology. Other morphologies point to different conditions: acanthocytes (spur cells) have irregular projections seen with liver/lipid disorders; target cells show a bull’s-eye appearance in various liver or hemoglobin-related conditions; echinocytes (burr cells) have evenly spaced spiky projections often linked to uremia or electrolyte issues.

In immune-mediated hemolytic anemia, red blood cells are coated by antibodies and often lose membrane material as they’re removed by the spleen. This creates small, round, dense cells that lack the central pallor—spherocytes. They’re the hallmark morphologic finding because they reflect membrane loss from the cell during immune attack and splenic clearance, which is central to IMHA’s pathology.

Other morphologies point to different conditions: acanthocytes (spur cells) have irregular projections seen with liver/lipid disorders; target cells show a bull’s-eye appearance in various liver or hemoglobin-related conditions; echinocytes (burr cells) have evenly spaced spiky projections often linked to uremia or electrolyte issues.