Normal Values:

Red blood cells normally are the same in size and color and have a lighter-colored area in the center. The blood smear is considered normal if there is:

• Normal appearance of cells
• Normal white blood cell differential

Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

What abnormal results mean:

Abnormal results mean there is an abnormality in the size, shape, color, or coating of the red blood cells.

Some abnormalities may be graded on a 4-point scale:

• 1+ means 25% of cells are affected
• 2+ means half of cells are affected
• 3+ means 75% of cells are affected
• 4+ means all of the cells are affected

The presence of target cells may be due to:

• Decreased osmotic fragility
• Deficiency of an enzyme called lecithin cholesterol acyl transferase
• Hemoglobin abnormalities (hemoglobinopathies)
• Iron deficiency
• Liver disease
• Spleen removal
• Thalassemia

The presence of sphere-shaped cells (spherocytes) may be due to:

• Autoimmune hemolytic anemia
• Hereditary spherocytosis
• Increased osmotic fragility

The presence of elliptocytes may be a sign of hereditary elliptocytosis or hereditary ovalocytosis.

The presence of fragmented cells (schistocytes) may be due to:

• Artificial heart valve
• Disseminated intravascular coagulation
• Hemolytic uremic syndrome (HUS)
• Microangiopathic hemolytic anemia
• Thrombotic thrombocytopenic purpura (TTP)

The presence of a type of immature red blood cell called a normoblast may be due to:

• Cancer that has spread to bone marrow
• Erythroblastosis fetalis
• Leukoerythroblastic anemia (myelophthisis process)
• Miliary tuberculosis
• Myelofibrosis
• Removal of spleen
• Severe hemolysis
• Thalassemia

The presence of burr cells (echinocytes) may indicate:

• Uremia

The presence of spur cells (acanthocytes) may indicate:

• Abetalipoproteinemia
• Severe liver disease

The presence of teardrop-shaped cells may indicate:

• Leukoerythroblastic anemia
• Myelofibrosis
• Severe iron deficiency
• Thalassemia major

The presence of Howell-Jolly bodies may indicate:

• Myelodysplasia
• Post-splenectomy
• Sickle cell anemia

The presence of Heinz bodies may indicate:

• Alpha thalassemia
• Congenital hemolytic anemia
• G6PD deficiency
• Unstable form of hemoglobin

The presence of slightly immature red blood cells (reticulocytes) may indicate:

• Anemia with bone marrow recovery
• Hemolytic anemia
• Hemorrhage

The presence of basophilic stippling may indicate:

• Lead poisoning
• Myelofibrosis
• Myelophthisic process

The presence of sickle cells may indicate sickle cell anemia.