Acanthocytes are not usually observed in normal live blood samples. The presence of acanthocytes suggest liver and spleen dysfunction.

The prefix “acantha” in Greek means “thorn”. 

Acanthocytes are abnormally shaped RBCs that have three to ten pronounced, irregular and blunt finger-like projections of varying length and width, rather like thorns. 


Acanthocytes are not usually observed in normal live blood samples. This finding is significant when seen during analysis,especially if observed in more than 3% of the total RBC sample.


  • Since the liver and spleen contribute to the maintenance of the RBC membranes, the presence of acanthocytes suggest liver and spleen dysfunction.
  • This abnormality of the RBC membrane is caused by a change in the lipid distribution in the RBC membrane, resulting in an altered membrane lipid composition. Acanthocytes have excess cholesterol in the cell membrane, which expands the outer leaflet of the lipid bilayer, resulting in blunt, irregular projections.
  • Essential Fatty Acid deficiency; Vitamin E deficiency
  • Kidney Stress & Potassium loss (ask about diuretic prescription drugs and look for echinocytes).
  • Potentially serious liver disease, such as Cirrhosis & Hepatitis)
  • High Cholesterol
  • Splenic dysfunction, Post-Splenectomy (surgical removal of the spleen). Acanthocytes are observed in these cases because macrophages (WBCs) in the spleen would normally remove these cells from the circulation.
  • Anorexia Nervosa
  • Cystic Fibrosis
  • Myelodisplasia
  • Hypothyroidism

Associated Symptoms:

  • Fatigue
  • Drowsiness
  • Poor circulation
  • Possible signs of liver disease
  • Asymptomatic in many cases

Pleomorphic Perspective:

The pathogenesis of acanthocytes in pleomorphism is the same as with the RBCs with single membrane protrusions. Both these forms develop as a result of the development of the bacterial phase of the endobiont’s life cycle. Bacterial rods can be seen emerging from RBCs. These are ascits of Leptotrichia buccalis, the bacterial phase of Mucor racemosus Fresen. They are associated with lowered or deficient resistance. In the case of acanthocytes, when many ascits can be seen emerging from the RBC, it is indicative of a strong endobiontic burden.

Medical Perspective:

The formation of acanthocytes is a consequence of a defect on the erythrocyte cell membrane. Projections from the cell membrane are irregular and distorted with the apex of the projections being pointed. This distorted shape results from an alteration of the lipid composition and fluidity of the erythrocyte membrane, caused by incorrectly synthesized beta-lipoprotein by the liver and a decreased replacement rate of the membrane cholesterol. Acanthocytosis is a red cell phenotype found in various underlying conditions. 

Abetalipoproteinaemia (Bassen-Kornzweig syndrome) and spur cell haemolytic anaemia of severe liver disease are the most frequent and most significant underlying conditions associated with acanthocytosis. Acanthocytes also occur in neuroacanthocytosis, anorexia nervosa and other malnutrition states, infantile pyknocytosis, McLeod syndrome, In (Lu)

null Lutheran phenotype, hypothyroidism, idiopathic neonatal hepatitis and myxoedema. They are also observed with transient haemolysis and stomatocytosis in individuals with alcoholism and with mild haemolysis and spherocytosis in individuals with

congestive splenomegaly. Other conditions associated with acanthocytes include homozygous familial hypobetalipoproteinaemia, Zieve syndrome and chronic granulomatous disease (CGD) associated with McLeod red cell phenotype.


Any combination of the following, depending on the rest of the case:


  • Avoid alcohol, caffeine, tobacco, saturated/animal fat, sugar, drugs and non-essential medication.
  • Hepaton (Neogenesis Health Products): 30 drops tincture 3x daily. May be increased to 5ml tincture 3xdaily.


  • Potassium supplement if kidney stress is suspected (correlate clinically).
  • Nephrocil (Neogenesis Health Products): 30 drops tincture 3x daily. May be increased to 5ml tincture 3xdaily.
  • Reduce animal protein and acid-forming foods.


  • Omega-3 supplement (1000-2000 EPA daily).
  • Vitamin E: start with 400mg daily and gradually increase to 800mg daily.
  • Buffered vitamin C (2500mg).


  • Increase water intake. To determine necessary daily water intake (in litres): Weight (kg) / 8) x 0.25.
  • Increase intake of fibre-rich carbohydrates (those tolerated by the blood type) and raw, polyunsaturated fats.
  • Avoid saturated fat, refined carbohydrates and food deficient in natural enzymes.
  • Avoid alcohol, caffeine, sugar, drugs and non-essential medication.
  • Raw vegetable juices, sprouts, greens and superfoods.
  • Increase essential minerals and electrolyte intake: Bio-Ionic Mineral Concentrate (Neogenesis Health Products).
  • Test & treat high cholesterol if high.
  • Treat hypothyroidism if present – Thyroid Formula (Neogenesis Health Products).

Working with Acanthocytes:

Most cases of mild acanthocytosis respond to nutritional interventions. Focus is placed on correcting dietary fat digestion, essential fatty acid deficiency, vitamin and trace mineral deficiencies, while supporting the liver, kidneys and other organs of elimination. If the condition does not improve further conventional investigations may be necessary (especially in cases with marked acanthocytosis).

Further Investigations:

  • FBC + differential + ESR
  • Liver function test (LFT)
  • Lipogram
  • Protein Electrophoresis
  • Urea, Electrolytes & Creatinine (UE+C)
  • Stool analysis
  • Peripheral blood smear microscopy
  • Thyroid Function Test
  • Direct Coombs Test

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