Dacrocytes

Dacrocytes, or teardrop cells, are abnormal red blood cells that assume a teardrop or pear-shaped silhouette on peripheral blood smear. The cell typically shows a narrow, pointed end opposite a rounded base and may vary in size and staining. Their presence is described as dacrocytosis.

Pathophysiology: Teardrop morphology arises when erythrocytes are deformed while traversing a stiffened or fibrotic bone marrow or during extramedullary hematopoiesis with splenomegaly. Conditions causing marrow infiltration or fibrosis create a constricted passage for erythrocytes, promoting progressive loss of biconcavity and elongation into a teardrop shape.

Clinical associations: Dacrocytosis is most characteristic of myelofibrosis and related myeloproliferative neoplasms with marrow fibrosis. It can also be observed in other myelophthisic states, such as marrow infiltration by metastatic tumors or granulomatous disease, and occasionally in severe iron deficiency anemia or thalassemia. The finding should prompt evaluation for underlying marrow disease and extramedullary hematopoiesis.

Diagnosis and interpretation: Detection depends on careful examination of the peripheral smear. Dacrocytes are not disease-specific; they require correlation with clinical presentation, complete blood count, reticulocyte count, iron studies, and, when indicated, marrow assessment.

Management and prognosis: There is no treatment aimed specifically at dacrocytosis. Therapy targets the underlying condition, such as management of myelofibrosis or iron deficiency. The appearance of teardrop cells may reflect marrow stress or advanced disease and can have prognostic implications in certain disorders.