Homozygous hemoglobin C (hemoglobin CC) is uncommon but can be suspected from the peripheral blood smear. The erythrocytes have less water than normal RBCs, a higher internal viscosity and a chloride-coupled potassium efflux.
Findings in the peripheral blood of a patient with hemoglobin CC:
(1) normocytic to microcytic red blood cells
(2) large numbers of spherocytes
(3) large number of target cells
(4) mild hemolytic anemia
(5) small numbers of hexagonal to rod-shaped hemoglobin crystals (which may appear in specimens following storage)
where:
• Target cells can be seen in many conditions such as hemoglobin EE and thalassemia.
• Spherocytes can be seen in several conditions such as hereditary spherocytosis, immune hemolysis.
• The presence of both in large numbers is highly suggestive of hemoglobin CC.
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