Which smear finding is most characteristic of hereditary elliptocytosis?

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Elliptocytes on the peripheral smear are the hallmark of hereditary elliptocytosis. The disorder arises from defects in the red cell membrane skeleton (such as spectrin or related proteins), which makes the cells less able to maintain a normal round shape and more prone to elongated, elliptical forms. This elongation is the most characteristic feature seen in HE and helps distinguish it from other causes of poikilocytosis.

Spherocytes, by contrast, are small, dense spheres resulting from membrane loss (seen in hereditary spherocytosis or autoimmune hemolytic anemia). Target cells appear with a bull’s-eye appearance and are associated with liver disease, thalassemia, or certain hemoglobinopathies. Stomatocytes have a mouth-shaped central pallor and are typical of other conditions like hereditary stomatocytosis or alcoholic liver disease.