#00063861

A 22-year-old man presented with a history of recurrent episodes of jaundice since childhood (>10 episodes), pain in the left hypochondriac region since the last 4 months, breathlessness and fatigue. On examination, he was found to have moderate splenomegaly. The full blood count was as follows: 

Hb = 111 g/l

MCV = 89 fl

MCHC = 342 g/l

WBC = 5.6 × 10⁹/l

Platelets = 177 × 10⁹/l.

The blood film showed anisocytosis, a few microspherocytes and polychromasia. Also observed were infrequent, but very evident mushroom-shaped erythrocytes (‘pincer cells’) ( Figures A & B, black arrows, Leishman ×100), and occasional NRBCs. The reticulocyte count was high (6.1%). Haptoglobin level was low (10 mg/dl; normal = 40 to 200 mg/dL). G6PD level was normal. The patient’s mother had also been detected with spherocytosis in the past, for which she underwent splenectomy.

Pincer cells are a characteristic feature of hereditary spherocytosis associated with protein Band-3 deficiency. They are formed due to the removal of two Heinz bodies from a single RBC, and may rarely be observed in oxidant-induced haemolysis. Their presence in two-thirds of patients with SARS-CoV-2 infection suggests a possible role for oxidative stress in the pathophysiology of the disease.