Spherocytes on a blood smear are most strongly associated with which condition?

• A. Immune-mediated hemolytic anemia (IMHA)
• B. Iron deficiency anemia
• C. Aplastic anemia
• D. Polycythemia

Answer: (A)

Spherocytes arise when red blood cells lose membrane surface area and become small, dense spheres with reduced central pallor. This membrane loss typically results from antibody-mediated destruction and removal of membrane by splenic macrophages, which is the hallmark of immune-mediated hemolytic anemia. So the smear finding of spherocytes most strongly points to immune-mediated hemolytic anemia.

Iron deficiency anemia usually shows microcytosis and hypochromia rather than sphere-shaped cells. Aplastic anemia affects all blood cell lines and doesn’t characteristically produce spherocytes. Polycythemia refers to an increased red cell mass and has different smear patterns rather than prominent spherocytes.