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The abnormality is thought to be due to membrane damage to the red cell during maturation in a crowded bone marrow environment, damage at the time of exit from the bone marrow and subsequent circulation through the spleen.
These cells are usually seen in disorders such as myelofibrosis, metastatic tumor in the bone marrow, extramedullary hematopoiesis, dyserythropoiesis, megaloblastic anemias, thalassemia especially in thalassemia major, acute leukemias, and in multiple myelomas.
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