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©2013 UpToDate ® Print Email Acanthocytes (spur cells) Peripheral blood smear shows multiple acanthocytes (spur cells). These cells have prominent irregular protrusions scattered over the surface in an asymmetrical pattern. They are often confused with echinocytes in which the protrusions are smaller and more regular. Courtesy of Carola von Kapff, SH (ASCP). Normal peripheral blood smear High power view of a normal peripheral blood smear. Several platelets (black arrows) and a normal lymphocyte (blue arrow) can also be seen. The red cells are of relatively uniform size and shape. The diameter of the normal red cell should approximate that of the nucleus of the small lymphocyte; central pallor (red arrow) should equal one-third of its diameter. Courtesy of Carola von Kapff, SH (ASCP).