Acanthocytes have coarse, weirdly spaced, variably sized crenations, resembling many-pointed stars. They are seen on blood films in, among others abetalipoproteinemia, liver disease, chorea acanthocytosis, McLeod syndrome, and several inherited neurological and other disorders, such as neuroacanthocytosis, anorexia nervosa, infantile pyknocytosis, hypothyroidism, idiopathic neonatal hepatitis, alcoholism, congestive splenomegaly, Zieve syndrome, and chronic granulomatous disease The presence of HbS in severe malaria patients is associated with less hemolysis and reduced levels of free heme any studies have described an association between the heterozygote HbAS and protection against malaria, with more than 90% protection against severe forms Ref Robbins 9/e pg 411