Mushroom-shaped red blood cells (pincer cells): a brief update

Red cells with cytoplasmic projections, resembling pincer-like cells, also known as mushroom- shaped red blood cells, as Figures 1 and 2, are usually associated with erythrocyte disorders, such as congenital dyserthropoietic anemias, hereditary spherocytosis associated with Banda-3 protein deficiency, disseminated intravascular coagulation, hemo-lytic-uremic syndrome, thrombotic thrombocytopenic purpura, kidney disease, microangiopathic hemolytic anemia, erythroleukemia and, more rarely, oxidative drug-induced hemolysis. However, a recent study have demonstrated a relationship between these cells and infection caused by Sars-CoV-2 in a pathophysiologic mechanism that possibly involves the occurrence of oxidative stress, which triggers progressive cascade of inflammation, known as citokines storm, that leads to red blood cell damage.¹, ², ³

Figure 1
Pincer cells in a patient with chronic kidney disease and diagnosed with COVID-19.

Figure 2
Pincer cells in a patient with chronic kidney disease and diagnosed with COVID-19.

REFERENCES

• ¹
  Gerard D, Ben Brahim S, Lesesve JF, Perrin J. Are mushroom-shaped erythrocytes an indicator of COVID-19? Br J Haematol. 2021(2):230.. https://doi.org/10.1111/bjh.17127 192 Epub 2021 Jan 5. PMID: 33399215.
  » https://doi.org/10.1111/bjh.17127
• ²
  Lesesve JF. Mushroom-shaped red blood cells in protein band-3 deficiency. Am J Hematol. 2011;86(8):694.. https://doi.org/10.1002/ajh.21962 PMID: 21761435.
  » https://doi.org/10.1002/ajh.21962
• ³
  McCann SR, Firth R, Murray N, Temperley IJ. Congenital dyserythropoietic anaemia type II (HEMPAS): a family study. J Clin Pathol. 1980;33(12):1197–201. https://doi.org/10.1136/jcp.33.12.1197 PMID: 7451666; PMCID: PMC1146375.
  » https://doi.org/10.1136/jcp.33.12.1197

Publication Dates

• Publication in this collection
  10 Oct 2022
• Date of issue
  Jul-Sep 2022

History

• Received
  12 Feb 2021
• Accepted
  20 May 2021
• Published
  09 July 2021