RBC Morphology

Differential List

Possible Concurrent Results

Comments

Microcytosis

*Iron-deficiency anemia, portocaval

shunt, copper or pyridoxine
deficiency, anemia of chronic disease

Decreased MCV, MCHC

Increased RDW
Hypochromasia
Poorly or non-regenerative

May be normal in Asian dog

breeds

Macrocytosis

1. Immature erythrocytes

1. Regenerative anemia

2. FeLV, myelodysplasia,
myeloproliferative disorder

2.

3. Macrocytosis of poodles

3. No anemia
Increased MCV
Increased nucleated RBCs
Increased H-J bodies
Hypersegmented neutrophils

4. Hereditary stomatocytosis

4. stomatocytes
Chondrodysplasia in Alaskan malamute
Hypertrophic gastritis in Drentse
partrijshond
No clinical disease in miniature schnauzers

3. Probably hereditary, no
clinical signs

Polychromasia

1. Extravascular hemolysis

1. Regenerative anemia
Bilirubinuria
Bilirubinemia
Neutrophilic leukocytosis

2. Acute Blood loss

2. Regenerative anemia
Decreased PP
Normal morphology

3. Hemangiosarcoma

3. Regenrative anemia
Decreased PP
Schistocytes
Acanthocytes

4. Intravascular hemolysis

Hypochromasia

1. Iron-deficiency anemia in dogs

4. Regenerative anemia
Hemoglobinuria
Hemoglobinemia
Agglutination
1. Increased MCV
Increased RDW
Microcytosis
Keratocytes
Schistocytes

Acanthocyte

1. Hepatic Lipidosis in cats

1. Icterus

2. Microangiopathy:
hemangiosarcoma, lymphosarcoma
of liver/spleen, hematoma

2. Regenerative anemia
Keratocytes
Schistocytes
Nucleated RBCs

Occurs in liver, spleen, bone

marrow

4. Complement mediated,
Bacterialtoxins, Parasites,
Hereditary, Other
chemicals/toxins

Keratocyte

1. Iron-deficiency anemia

1. Increased MCV
Increased RDW
Microcytosis
Keratocytes
Schistocytes

Schistocyte

1. DIC

1. Thrombocytopenia
Regenerative anemia

2. Vascular neoplasms;
hemangiosarcoma

2. Regenerative anemia
Keratocytes
Acanthocytes

3. Iron-deficiency anemia due to

oxidative injury

3. Increased MCV
Increased RDW
Microcytosis
Keratocytes
Schistocytes

Echinocytes (Burr cells)

1. Artifact/ crenation
2. Renal disease

2. Increased BUN, creatinine

decreased urine specific gravity

3. Lymphoma
4. Rattlesnake bite (type 3)
5. Chemotherapy in dogs
6. Exercise in horses
Spherocyte

1. Immune-mediated hemolytic
anemia

1. Regenerative or pre-regenerative anemia

Agglutination

Not appreciated in in species

other than dogs

2. Mismatched blood transfusion

3. Zinc toxicosis

3. Usually causes Heinz

body anemia

4. Bee stings

Eccentrocyte
(no picture; lopsided-looking cell with
most hemoglobin on one side)
Codocyte/leptocyte aka target cell

1. Oxidative damage

1. Heinz bodies

2. Glucose-6-dehydrogenase
deficiency
Little clinical significance

2. Heinz bodies

1. Artifact of excessive EDTA

2. Increased serum cholesterol in
dogs

Stomatocyte

1. Hereditary stomatocytosis

1. Chondrodysplasia in Alaskan malamute

Hypertrophic gastritis in Drentse partrijshond
No clinical disease in miniature schnauzers

Heinz Bodies

1. Diabetes mellitus in cats

May cause intravascular hemolysis severe

hemolytic anemia if many RBCs are affected

Caused by oxidative
denaturation of hemoglobin

2. Lymphoma
3. Hyperthyroidism
4. Oxidative drugs and compounds

Basophilic stippling

1. Immature RBCs in ruminants,

cats, dogs
2. Lead poisoning

4. Onions, garlic, Brassica sp

plants, dried or wilted red
maple leaves, benzocaine,
zinc, copper, acetominophen,
propfol, naphthalene, vitamin
K, methylene blue, propylene
glycol
1. Regenerative anemia

Howell-Jolly bodies

1. Regenerative anemia

1. Reticulocytes/ polychromasia
Increased MCV
Nucleated RBCs

2. splenectomy/ suppressed spleen

function

Nucleated RBCs

1. Regenerative anemia

1. Reticulocytes/
polychromasia
Increased MCV
Howell-Jolly bodies

2. Lead poisoning

2. Increased nucleated RBCs out of proportion

with degree of anemia

3. Nonfunctioning
spleen/splenectomy
4. Increased corticosteroids
5. Myelodysplasia or
myeloproliferative disease in cats

5. Lack of polychromasia

Siderotic granules/ Pappenheimer

bodies

1. Impaired heme synthesis

2. Chloramphenicol therapy
3. Myelodysplasia
4. Ineffective erythropoiesis of
unknown cause

Agglutination

1. IMHA

1. Regenerative anemia
Spherocytes
Falsely increased MCV
Falsely decreased RBC count

2. Mismatched blood trransfusion

Rouleaux formation

1. gammopathy

1. Increased PP

2. multiple myeloma

2. Increased PP

Normal in horses; slight

rouleaux normal in dogs and
cats

Regenerative Anemia
.

Macrocytosis
Increased MCV (not so much in dogs)
Decreased MCHC
Polychromasia
Reticuloytes (not in horses)
Basophilic stippling (ruminants)
Serial increases in MCV (horses)
Increased RDW
Nucleated RBCs
Howell-Jolly bodies
Hypochromasia