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Damaged cells are cleared by macrophages in the spleen, where the precipitate and damaged membrane are removed, leading to characteristic "bite cells". The denaturing process is irreversible and the continual elimination of damaged cells leads to Heinz body anemia. There are several pathways leading to the hemoglobin damage.
A degmacyte or bite cell is an abnormally shaped mature red blood cell with one or more semicircular portions removed from the cell margin, known as "bites". [1] [2] These "bites" result from the mechanical removal of denatured hemoglobin during splenic filtration as red cells attempt to migrate through endothelial slits from splenic cords into the splenic sinuses. [3]
Acanthocyte-like cells may be found in hypothyroidism, after splenectomy, and in myelodysplasia. [12] Acanthocytes should be distinguished from echinocytes, which are also called 'burr cells', which although crenated are dissimilar in that they have multiple, small, projecting spiculations at regular intervals on the cell membrane.
By counting the number of such cells the rate of red blood cell formation can be determined, providing an insight into bone marrow activity and anemia. [3] This is in contrast to vital staining , when the dye employed is one that is excluded from the living cells so that only dead cells are stained positively.
Scanning electron microscopy (SEM) of echinocytes Echinocyte compared to other forms of poikilocytosis. Echinocyte (from the Greek word echinos, meaning 'hedgehog' or 'sea urchin'), in human biology and medicine, refers to a form of red blood cell that has an abnormal cell membrane characterized by many small, evenly spaced thorny projections.
The underlying cause of sickle cell anemia is the synthesis of aberrant hemoglobin, which attaches to other aberrant hemoglobin molecules inside the red blood cell to undergo rigid deformation. [18] Sickle cell anemia symptoms usually appear around the age of six months. They can change over time and differ from person to person.
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Microangiopathic hemolytic anemia may be suspected based on routine medical laboratory tests such as a CBC (complete blood cell count). Automated analysers (the machines that perform routine full blood counts in most hospitals) are designed to flag blood specimens that contain abnormal amounts of red blood cell fragments or schistocytes. [2]