{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T09:55:57Z","timestamp":1790589357155,"version":"4.1.0"},"reference-count":18,"publisher":"Walter de Gruyter GmbH","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_cclm-2026-0957_abs_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Red blood cell (RBC) morphology in peripheral blood smears (PBS) remains essential for the differential diagnosis of anemia and other hematologic disorders. As yet\u00a0unclassified poikilocytes, fish-shaped RBCs and pincer (mushroom-shaped) cells are rarely observed but have been described as \u201cbizarre erythrocytes\u201d and linked to hereditary spherocytosis. This study aimed to investigate their relevance across a spectrum of hematologic diseases and provide a basis for future morphological standardization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2026-0957_abs_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Peripheral blood smears from 251 specimens were systematically reviewed, including cases of iron deficiency anemia (IDA), \u03b2-thalassemia minor (BTM), sickle cell disease (SCD), microangiopathic hemolytic anemia (MAHA), autoimmune hemolytic anemia (AIHA), hereditary spherocytosis (HS), hereditary elliptocytosis (HE), vitamin B12\/folate deficiency, myelodysplastic neoplasms (MDS), primary myelofibrosis (PMF), malaria, liver disease (LD), and healthy controls. Abnormal RBC morphologies were quantified as cells per 20\u00a0high-power fields at 1,000\u00a0\u00d7\u00a0magnification. Group comparisons used the Mann\u2013Whitney U test and correlations were assessed by Spearman\u2019s rank correlation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2026-0957_abs_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Numbers of fish-shaped and pincer cells were significantly increased in IDA, BTM, MDS, HE, PMF, and vitamin B12\/folate deficiency with a strong positive intercorrelation (p&lt;0.01) in most of these diseases. Pincer cells were also elevated in HS and hemoglobin levels were negatively correlated with both fish and pincer cells across all disorders studied (p&lt;0.0001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2026-0957_abs_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Fish-shaped RBCs and pincer cells represent abnormal erythrocyte morphologies associated with a range of hematologic disorders and correlate with severity of anemia. Their strong intercorrelation suggests a shared pathophysiologic mechanism or may reflect different stages of a common morphological process.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/cclm-2026-0957","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T14:56:58Z","timestamp":1783349818000},"page":"2573-2579","source":"Crossref","is-referenced-by-count":0,"title":["Fish-shaped erythrocytes and pincer cells co-occur in distinct hematological disorders and are associated with anemia severity"],"prefix":"10.1515","volume":"64","author":[{"given":"Anna Lena","family":"Lembeck","sequence":"first","affiliation":[{"name":"Department of Internal Medicine , Hospital of the Brothers of St. John of God , Graz , Austria"},{"name":"Department of Internal Medicine, Division of Hematology , Medical University of Graz , Graz , Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"W\u00f6lfler","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Hematology , Medical University of Graz , Graz , Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armin","family":"Zebisch","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Hematology , Medical University of Graz , Graz , Austria"},{"name":"Otto-Loewi Research Center for Vascular Biology, Immunology and Inflammation, Division of Pharmacology , Medical University of Graz , Graz , Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Robier","sequence":"additional","affiliation":[{"name":"Institute of Laboratory Diagnostics , Hospital of the Brothers of St. John of God , Graz , Austria"},{"name":"Clinical Institute of Medical and Chemical Laboratory Diagnostics , Medical University of Graz , Graz , Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,7,7]]},"reference":[{"key":"2026092809015504243_j_cclm-2026-0957_ref_001","doi-asserted-by":"crossref","unstructured":"Bain, BJ. Diagnosis from the blood smear. N\u00a0Engl J Med 2005;353:498\u2013507. https:\/\/doi.org\/10.1056\/nejmra043442.","DOI":"10.1056\/NEJMra043442"},{"key":"2026092809015504243_j_cclm-2026-0957_ref_002","doi-asserted-by":"crossref","unstructured":"Chase, ML, Drews, R, Zumberg, MS, Ellis, LR, Reid, EG, Gerds, AT, et al.. Consensus recommendations on peripheral blood smear review: defining curricular standards and fellow competency. Blood Adv 2023;7:3244\u201352. https:\/\/doi.org\/10.1182\/bloodadvances.2023009843.","DOI":"10.1182\/bloodadvances.2023009843"},{"key":"2026092809015504243_j_cclm-2026-0957_ref_003","doi-asserted-by":"crossref","unstructured":"Ford, J. Red blood cell morphology. Int J Lab Hematol 2013;35:351\u20137. https:\/\/doi.org\/10.1111\/ijlh.12082.","DOI":"10.1111\/ijlh.12082"},{"key":"2026092809015504243_j_cclm-2026-0957_ref_004","doi-asserted-by":"crossref","unstructured":"Dhermy, D, Galand, C, Bournier, O, Boulanger, L, Cynober, T, Schismanoff, PO, et al.. Heterogeneous band 3 deficiency in hereditary spherocytosis related to different band 3 gene defects. Br J Haematol 1997;98:32\u201340. https:\/\/doi.org\/10.1046\/j.1365-2141.1997.1893005.x.","DOI":"10.1046\/j.1365-2141.1997.1893005.x"},{"key":"2026092809015504243_j_cclm-2026-0957_ref_005","doi-asserted-by":"crossref","unstructured":"G\u00e9rard, D, Ben Brahim, S, Lesesve, JF, Perrin, J. Are mushroom-shaped erythrocytes an indicator of COVID-19? Br J Haematol 2021;192:230. https:\/\/doi.org\/10.1111\/bjh.17127.","DOI":"10.1111\/bjh.17127"},{"key":"2026092809015504243_j_cclm-2026-0957_ref_006","doi-asserted-by":"crossref","unstructured":"Dienstmann, G, Barbosa dos Santos, V, Comar, SR. Mushroom-shaped red blood cells (pincer cells): a brief update. 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