On peripheral blood smear, autoimmune hemolytic anemia typically shows which finding?

• A. Spherocytes
• B. Drepanocytes
• C. Acanthocytes
• D. Target cells

Answer: (A)

Autoimmune hemolytic anemia arises when antibodies bind red blood cells, marking them for destruction by the spleen. As the spleen removes the antibody-coated membrane, each red cell loses membrane surface area and becomes smaller and rounder. This loss of membrane relative to volume makes the cells sphere-shaped with reduced central pallor, known as spherocytes. On a peripheral smear, spherocytes are dense, small, and lack the normal central clearing, which is the hallmark finding in this setting. Other shapes like sickle cells, spur cells, or target cells point to different diseases, not typical immune-mediated hemolysis.