Images show peripheral blood smears with schistocytes present (indicated by the arrow). From MLS Collection, University of Alberta.

Image 1: 100x oil immersion. https://doi.org/10.7939/R34Q7R51T

Image 2: 50x oil immersion. https://doi.org/10.7939/R3N29PN8H

Image 3: https://doi.org/10.7939/R31R6NG3M

Cell Description:

Fragmented red blood cells with varying shapes and sizes. Cells often appear small, with multiple pointed and angular ends and lack an area of central pallor.^1,2

Cell Formation:

Formed in circulation when a red blood cell is damaged by mechanical means (e.g. damaged by fibrin strands or mechanical heart valves). The presence of schistocytes suggests an intravascular hemolytic process is occurring^2,3

Associated Disease/Clinical States:^1,2,4,5

Microangiopathic Hemolytic Anemia (MAHAs)

Macroangiopathic Hemolytic Anemias

Renal graft rejection

Severe burns

References:

1. Rodak BF, Carr JH. Variations in shape and distribution of  erythrocytes. In: Clinical hematology atlas. 5th ed. St. Louis, Missouri: Elsevier Inc.; 2017. p. 93-106.

2. Ford J. Red blood cell morphology. Int J Lab Hematol [Internet]. 2013 Mar 9 [cited 2018 Jul 12];35(3):351–7. Available from: https://doi.org/10.1111/ijlh.12082

3. Landis-Piwowar K, Landis J, Keila P. The complete blood count and peripheral blood smear evaluation. In: Clinical laboratory hematology. 3rd ed. New Jersey: Pearson; 2015. p. 154-77.

4. Jones KW. Evaluation of cell morphology and introduction to platelet and white blood cell morphology.  In: Clinical hematology and fundamentals of hemostasis. 5th ed. Philadelphia: F.A. Davis Company; 2009. p. 93-116.

5. Manchanda N. Anemias: red blood morphology and approach to diagnosis. In: Rodak’s hematology clinical applications and principles. 5th ed. St. Louis, Missouri: Saunders; 2015. p. 284-96.