As previously mentioned, tear drop cells are present in disorders with altered splenic or bone marrow structure. Disrupted splenic cords and myelofibrosis with myeloid metaplasia are examples.

• Tear drop cells appear in the peripheral blood as a response to red cell alterations by thalassemia when red cell inclusions are expelled by a stripping process through splenic cords.
• A marrow disrupted by malignant cells may also set the stage for release of teardrop cells into the peripheral blood.
• Importantly, teardrop cells may arise as an artifact of improper smear preparation, identified by their uniformity in pointing in the same direction.
• In contrast, teardrops noted in the photograph are irregularly arranged and oriented in various directions. Teardrops always have pointed ends and disappear after splenectomy.