Summary In diseases of the liver or biliary tract increased surface area (macroplania) is related either to macrocytosis or to leptocytosis. In a study on 20 patients with macroplania associated with leptocytosis, but without target cells, the following observations were made.
There was a positive correlation between changes in MCD and serum bilirubin.
There was a negative correlation between MCD and osmotic fragility.
There was a positive correlation between MCD and mean amount of cholesterol per erythrocyte and per μm2 of erythrocyte surface area, but there was no correlation between mean amount of cholesterol per erythrocyte and serum concentration of free or total cholesterol.
The osmotic fragility of normal erythrocytes introduced into the circulation of patients with leptocytosis became similar to the (diminished) osmotic fragility of the patients' own erythrocytes.
The order in which the changes occur is probably as follows: changes in the peripheral circulation→increase in the mean amount of cholesterol per erythrocyte and per unit of erythrocyte surface area→increase in mean erythrocyte surface area while the MCV remains normal→increase of MCD and diminution of MCT→diminution of osmotic fragility.