Red cells with cytoplasmic projections, resembling pincer-like cells, also known as mushroom- shaped red blood cells, as Figures 1 and 2, are usually associated with erythrocyte disorders, such as congenital dyserthropoietic anemias, hereditary spherocytosis associated with Banda-3 protein deficiency, disseminated intravascular coagulation, hemolytic-uremic syndrome, thrombotic thrombocytopenic purpura, kidney disease, microangiopathic hemolytic anemia, erythroleukemia and, more rarely, oxidative drug-induced hemolysis. However, a recent study have demonstrated a relationship between these cells and infection caused by Sars-CoV-2 in a pathophysiologic mechanism that possibly involves the occurrence of oxidative stress, which triggers progressive cascade of inflammation, known as citokines storm, that leads to red blood cell damage.1–3

Figure 1.

Pincer cells in a patient with chronic kidney disease and diagnosed with COVID-19.

Figure 2.

Pincer cells in a patient with chronic kidney disease and diagnosed with COVID-19.