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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter


IMPACT FACTOR 2018: 3.638

CiteScore 2018: 2.44

SCImago Journal Rank (SJR) 2018: 1.191
Source Normalized Impact per Paper (SNIP) 2018: 1.205

Online
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1437-4331
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Volume 56, Issue 2

Issues

The frequency of occurrence of fish-shaped red blood cells in different haematologic disorders

Christoph Robier
  • Corresponding author
  • Institute of Laboratory Diagnostics, Hospital of the Brothers of St. John of God, Bergstr. 27, 8020 Graz, Austria, Phone: +43 316 5989 26671, Fax: +43 316 5989 21505
  • Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Carolin Körber / Franz Quehenberger
  • Institute of Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Manfred Neubauer / Albert Wölfler
Published Online: 2017-07-21 | DOI: https://doi.org/10.1515/cclm-2017-0378

Abstract

Background:

Red blood cells (RBC) resembling the silhouette of a fish are rarely observed in peripheral blood (PB) smears. In this study, we determined the frequency of occurrence of fish-shaped RBC in different haematologic diseases.

Methods:

We examined PB smears of patients with iron deficiency anaemia (IDA) (n=23), β-thalassaemia minor (BTM) (n=30), sickle cell disease (SCD) (n=7), autoimmune haemolytic anaemia (AIHA) (n=13), microangiopathic haemolytic anaemia (MAHA) (n=11), hereditary sphaerocytosis (HS) (n=4), hereditary elliptocytosis (HE) (n=3), vitamin B12 and folate deficiency (n=15), anaemia in liver disease (LD) (n=17), myelodysplastic syndrome (MDS) (n=15), acute myeloid leukaemia (AML) (n=29), chronic myeloid leukaemia (CML) (n=18), primary myelofibrosis (PMF) (n=12), chronic myelo-monocytic leukaemia (CMML) (n=15) and 21 healthy controls by light microscopy for the occurrence of fish-shaped erythrocytes. The fish-shaped RBC were counted as cells per 20 high-power fields (HPF) at 1000-fold magnification, and slides containing ≥1 fish-shaped RBC/20 HPF were regarded as positive.

Results:

Fish-shaped RBC were significantly found in HE, iron deficiency, vitamin B12/folate deficiency, LD and PMF. The highest numbers of fish-shaped RBC were seen in HE and vitamin B12/folate deficiency. In patients with BTM, MDS, AML and CMML, this RBC anomaly was only occasionally observed. Furthermore, a statistically significant negative correlation of haemoglobin with the occurrence of fish-shaped RBC was apparent (p<0.014).

Conclusions:

Our data show that the occurrence of fish-shaped RBC is suggestive of a pathologic condition, especially IDA, HE, vitamin B12 or folate deficiency, primary mylofibrosis or LD, and is significantly associated with severity of anaemia.

Keywords: erythrocytes; fish cells; fish-shaped erythrocytes; poikilocytes; red blood cell morphology

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About the article

Corresponding author: Christoph Robier, MD, PD, Institute of Laboratory Diagnostics, Hospital of the Brothers of St. John of God, Bergstr. 27, 8020 Graz, Austria, Phone: +43 316 5989 26671, Fax: +43 316 5989 21505


Received: 2017-05-03

Accepted: 2017-06-09

Published Online: 2017-07-21

Published in Print: 2018-01-26


Author contributions: C.R. is the principal investigator and he designed the study, performed microscopic examinations and wrote the manuscript; K.C., F.Q., M.N. and A.W. contributed to designing the study, conducting the work, interpreting the results and editing of the manuscript. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.


Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), Volume 56, Issue 2, Pages 323–326, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/cclm-2017-0378.

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