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eFigure 15–1. Normal peripheral blood smear. The RBCs are uniform in size and shape with small central pallor. Normal RBCs are the size of a small lymphocyte nucleus (the center leukocyte shown). Also shown is a polymorphonuclear neutrophil (upper leukocyte) and a monocyte (lower leukocyte). The small purple bodies are platelets. The upper inset is an eosinophil (eosinophilic granules do not cover the nuclei) and the lower is a basophil (basophilic granules do sit on the nuclei). (Used, with permission, from Andrew D. Leavitt, MD.) Two micrographs of a normal peripheral blood smear in high and low magnification.

Current Medical Diagnosis & Treatment 2025 > Anemias

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eFigure 15–1. Normal peripheral blood smear. The RBCs are uniform in size and shape with small central pallor. Normal RBCs are the size of a small lymphocyte nucleus (the center leukocyte shown). Also shown is a polymorphonuclear neutrophil (upper leukocyte) and a monocyte (lower leukocyte). The small purple bodies are platelets. The upper inset is an eosinophil (eosinophilic granules do not cover the nuclei) and the lower is a basophil (basophilic granules do sit on the nuclei). (Used, with permission, from Andrew D. Leavitt, MD.) Two micrographs of a normal peripheral blood smear in high and low magnification.

Current Medical Diagnosis & Treatment 2025 > Anemias

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eFigure 15–2. Iron deficiency anemia, on peripheral blood smear. Virtually all the cells are hypochromic with a pale center and only a thin rim of hemoglobin (arrow). The cells are also smaller than normal (microcytic) as judged by comparison to the size of the nucleus of the typical small lymphocyte shown. (Reproduced, with permission, from Lichtman MA, Shafer MS, Felgar RE, Wang N. Lichtman's Atlas of Hematology. McGraw-Hill, 2016.) A micrograph of the blood smear from a case of iron deficiency anemia. There are small, red cells with increased pallor and a thin, pink border of hemoglobin, indicated by arrows.

Current Medical Diagnosis & Treatment 2025 > Iron Deficiency Anemia

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eFigure 15–3. Hemoglobin H disease, on peripheral blood smear. Note strikingly small RBCs (microcytosis), with pallor and thin rim of hemoglobin (hypochromia), and abnormally shaped RBCs (poikilocytes), including target cells. (Reproduced, with permission, from Lichtman MA, Shafer MS, Felgar RE, Wang N. Lichtman's Atlas of Hematology. McGraw-Hill, 2016.) A micrograph of the blood smear from a case of Hemoglobin H disease reveals small, abnormally shaped red blood cells with pale centers and pink borders. Some of the cells have a bull's eye appearance with a red border and a red center, and some are elongated.

Current Medical Diagnosis & Treatment 2025 > The Thalassemias

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eFigure 15–4. Thalassemia minor, beta, on peripheral blood smear. The red cells are small (microcytic). Compare cell areas to that of small lymphocyte nucleus. The red cells are pale (hypochromic) on average. There is marked variation in hemoglobin content of RBCs (anisochromia) and marked variation in RBC size (anisocytosis). Misshapen red cells (poikilocytes) are frequent, including teardrop, oval, elliptical, and fragmented cells. The arrow points to a stippled red cell, characteristic of thalassemia minor and a very important distinguishing feature from iron deficiency anemia, which does not have stippled red cells as a feature. (Reproduced, with permission, from Lichtman MA, Shafer MS, Felgar RE, Wang N. Lichtman's Atlas of Hematology. McGraw-Hill, 2016.) A micrograph of the blood smear from a case of beta thalassemia minor. There are multiple cells with abnormal shapes, including tear drop, elliptical, and fragmented. An arrow indicates a stippled red cell.

Current Medical Diagnosis & Treatment 2025 > The Thalassemias

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eFigure 15–5. Beta-thalassemia major, on peripheral blood smear. Note that, on average, the RBCs are severely microcytic and hypochromic cells are prevalent. There is marked variation in hemoglobin content of RBCs (anisochromia) and marked variation in RBC size (anisocytosis). Misshapen RBCs (poikilocytes) are frequent, including teardrop, oval, elliptical, and fragmented cells. A nucleated RBC is present (lower right) as is a typical small lymphocyte (lower left). (Reproduced, with permission, from Lichtman MA, Shafer MS, Felgar RE, Wang N. Lichtman's Atlas of Hematology. McGraw-Hill, 2016.) A micrograph of the blood smear from a case of beta thalassemia major. The image reveals severe microcytosis, anisocytosis, and poikilocytosis. Two dark blue hypochromic cells are seen, along with a nucleated red cell and a small lymphocyte.

Current Medical Diagnosis & Treatment 2025 > The Thalassemias

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eFigure 15–8. Megaloblastic anemia due to vitamin B12 deficiency, peripheral blood smear. The RBCs exhibit marked variation in RBC size (anisocytosis), ranging from macrocytes to microcytes. Misshapen RBCs (poikilocytes) are present. Occasional spherocytes are noted. The cells are normochromic. The asterisks indicate the classical oval macrocytes that are hallmarks of megaloblastic anemia. (Reproduced, with permission, from Lichtman MA, Shafer MS, Felgar RE, Wang N. Lichtman's Atlas of Hematology. McGraw-Hill, 2016.) A micrograph of the blood film from a case of megaloblastic anemia. The image reveals oval, large, red blood cells, with reduced central pallor.

Current Medical Diagnosis & Treatment 2025 > Vitamin B₁₂ Deficiency

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eFigure 15–9. Megaloblastic anemia as a result of vitamin B12 or folate deficiency, peripheral blood smear. Shown are characteristic findings of oval macrocytes, anisocytosis, and poikilocytosis; also shown is a hypersegmented polymorphonuclear neutrophil. (Reproduced, with permission, from Lichtman MA, Shafer MS, Felgar RE, Wang N. Lichtman's Atlas of Hematology. McGraw-Hill, 2016.) A micrograph of the blood film from a case of megaloblastic anemia. The image reveals large, oval macrocytes, smaller microcytes, slit cells, and a neutrophil with a dark, hyper segmented nucleus.

Current Medical Diagnosis & Treatment 2025 > Vitamin B₁₂ Deficiency

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eFigure 15–11. Glucose-6-phosphate dehydrogenase deficiency, peripheral blood smear. The two arrows point to keratocytes or “bite” cells, characteristic of hemolytic disease induced by oxidative stress (eg, ingestion of a drug) in patients with this RBC enzyme deficiency. The deformity is thought to result from oxidative damage to a portion of the RBC membrane leading to an appearance as if a “bite” was taken out of it. (Reproduced, with permission, from Lichtman MA, Shafer MS, Felgar RE, Wang N. Lichtman's Atlas of Hematology. McGraw-Hill, 2016.) A micrograph of the blood film from a case of G 6 P D deficiency. The image reveals several bite cells, normally shaped red blood cells that appear to have a bite taken out from one side. Two of the bite cells are indicated by arrows.

Current Medical Diagnosis & Treatment 2025 > Glucose-6-Phosphate Dehydrogenase Deficiency

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eFigure 15–12. Heinz bodies, peripheral blood stained with a supravital stain (such as crystal violet). These bodies are particles of denatured hemoglobin, usually appearing as purple inclusions attached to the inner face of the RBC membrane. Drugs may result in the oxidative denaturation of hemoglobin in glucose-6-phosphate dehydrogenase deficient individuals (eg, primaquine), in normal individuals (eg, phenylhydrazine), or in individuals with unstable hemoglobin mutants. (Reproduced, with permission, from Lichtman MA, Shafer MS, Felgar RE, Wang N. Lichtman's Atlas of Hematology. McGraw-Hill, 2016.) A micrograph of the blood film reveals numerous Heinz bodies. They appear as round, dark purple deposits within the red blood cells.

Current Medical Diagnosis & Treatment 2025 > Glucose-6-Phosphate Dehydrogenase Deficiency

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eFigure 15–13. Sickle cell disease, peripheral blood smear. In this patient with hemoglobin SS disease, there are two characteristic cells (arrows). One is the classic crescent shaped cell pathognomonic of sickle cell disease. The other is an elliptical RBC with condensation of hemoglobin leaving a paler outer rim of cytoplasm, also characteristic of hemoglobin SS. Also present in the center of the smear are two target cells. (Reproduced, with permission, from Lichtman MA, Shafer MS, Felgar RE, Wang N. Lichtman's Atlas of Hematology. McGraw-Hill, 2016.) A micrograph of the blood film from a case of sickle cell disease. The image reveals crescent shaped cells, indicated by arrows. There are also elongated cells, and target cells with dark borders, internal pallor, and dark centers.

Current Medical Diagnosis & Treatment 2025 > Sickle Cell Anemia & Related Syndromes

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eFigure 15–14. Sickle cell disease, peripheral blood smear. A: Pretransfusion blood smear shows numerous sickle cells. B: Posttransfusion shows a greatly reduced frequency of sickle cells. (Reproduced, with permission, from Lichtman MA, Shafer MS, Felgar RE, Wang N. Lichtman's Atlas of Hematology. McGraw-Hill, 2016.) Two micrographs of the blood smear from a case of sickle cell disease taken before and after transfusion.

Current Medical Diagnosis & Treatment 2025 > Sickle Cell Anemia & Related Syndromes

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eFigure 15–15. Hemoglobin CC disease, peripheral blood smear. In this patient who is post-splenectomy, it is easy to note characteristic elliptical crystal-like precipitates of hemoglobin C as well as markedly increased frequency of target cells. The RBC inclusion in the upper right corner is a Howell Jolly body, indicative of the asplenic state. (Reproduced, with permission, from Lichtman MA, Shafer MS, Felgar RE, Wang N. Lichtman's Atlas of Hematology. McGraw-Hill, 2016.) A micrograph of the blood film from a case of Hemoglobin C C disease. The reveals numerous target cells, which have dark borders, pallor, and dark centers. There are dark elliptical precipitates, and a tiny, dark spherical inclusion in the top right of the field.

Current Medical Diagnosis & Treatment 2025 > Hemoglobin C Disorders

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eFigure 15–16. Autoimmune hemolytic anemia, warm antibody type, peripheral blood smear. Spherocytes are markedly increased in number. In the center, there is an example of erythrophagocytosis (a leukocyte with ingestion of two RBCs). (Reproduced, with permission, from Lichtman MA, Shafer MS, Felgar RE, Wang N. Lichtman's Atlas of Hematology. McGraw-Hill, 2016.) A micrograph of the blood film from a case of autoimmune hemolytic anemia. The image reveals numerous spherical red cells with reduced pallor, and two red cells within a single, dark leukocyte.

Current Medical Diagnosis & Treatment 2025 > Autoimmune Hemolytic Anemia

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eFigure 15–17. Hemolytic-uremic syndrome, peripheral blood smear. Characteristic findings include anisocytosis (RBCs of varying size), spherocytosis (RBCs that are sphere-shaped rather than biconcave disks), and poikilocytosis (RBCs that are abnormally shaped) as well as an absence of platelets, reflecting a marked thrombocytopenia (low platelet level). The fragmented RBCs with pointed ends are schistocytes, consistent with this being a microangiopathic process. (Reproduced, with permission, from Lichtman MA, Shafer MS, Felgar RE, Wang N. Lichtman's Atlas of Hematology. McGraw-Hill, 2016.) A micrograph of the blood film from a case of hemolytic uremic syndrome. The image reveals blood cells of varying sizes, some with reduced pallor. Some cells appear spherical in shape, and some are fragmented.

Current Medical Diagnosis & Treatment 2025 > Microangiopathic Hemolytic Anemias

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eFigure 15–20. Hereditary elliptocytosis, peripheral blood smear. There is a range of abnormally shaped RBCs, with changes varying from oval cells (arrow) to elliptical cells (asterisk) to very small and distorted RBCs. There are also several teardrop-shaped cells (dacrocytes). Occasional cells have lost their biconcavity and are very dense (hyperchromatic). (Reproduced, with permission, from Lichtman MA, Shafer MS, Felgar RE, Wang N. Lichtman's Atlas of Hematology. McGraw-Hill, 2016.) A micrograph of the blood film from a case of hereditary elliptocytosis, reveals numerous poikilocytes, including tear drop, spherical, and elliptical shaped cells. There are several fragmented cells as well.

Current Medical Diagnosis & Treatment 2025 > Polycythemia Vera

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eFigure 15–21. Primary myelofibrosis, peripheral blood smears. A: In classical idiopathic myelofibrosis, teardrop-shaped RBCs (dacrocytes) and nucleated RBCs are characteristically present throughout, along with a few other poikilocytes (abnormally shaped RBCs). B: Again, note prevalence of teardrop RBCs, other poikilocytes, nucleated RBCs. A basophil is present in the lower right. The other fields also demonstrate left shifted granulocytes (metamyelocytes, myelocytes, promyelocytes, possibly blasts). The triad of nucleated RBCs, dacrocytes, and left shifted granulocytes make this a leukoerythroblastic blood smear, typical of myelofibrosis and other marrow infiltrative diseases. (Reproduced, with permission, from Lichtman MA, Shafer MS, Felgar RE, Wang N. Lichtman's Atlas of Hematology. McGraw-Hill, 2016.) Two micrographs of blood smears from a case of primary myelofibrosis.

Current Medical Diagnosis & Treatment 2025 > Primary Myelofibrosis

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eFigure 15–23. Chronic myelogenous leukemia (CML), peripheral blood smear. CML is indicated by presence of promyelocytes, myelocytes, metamyelocyte, bands, and segmented neutrophils. A myeloblast is seen in the lower portion of the field. There is also a basophilic myelocyte in the upper right corner. Under low power, the marked increase in WBC count suggested here can be better appreciated. (Reproduced, with permission, from Lichtman MA, Shafer MS, Felgar RE, Wang N. Lichtman's Atlas of Hematology. McGraw-Hill, 2016.) A micrograph of the blood film from a case of chronic myelogenous leukemia.

Current Medical Diagnosis & Treatment 2025 > Chronic Myeloid Leukemia

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eFigure 15–26. Myelodysplasia. Peripheral blood smear. Macrocytosis with poikilocytosis including ovalocytes, elliptocytes, and teardrop-shaped cells. (Adapted, with permission, from Lichtman MA, Shafer MS, Felgar RE, Wang N. Lichtman's Atlas of Hematology. McGraw-Hill, 2016.) A micrograph of the blood film from a case of myelodysplasia, reveals hypo lobulated neutrophils and macrocytes. There are two neutrophils with blue nuclei near the center of the field.

Current Medical Diagnosis & Treatment 2025 > Myelodysplastic Neoplasms

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eFigure 15–35. Plasma cell myeloma, peripheral blood smear. Characteristic of myeloma are pathological rouleaux formations, linear rows of overlapping RBCs in an apparent “stack.” Rouleaux occurs in clonal lymphoid diseases with monoclonal Ig in the blood, whose molecules facilitate the linear associations of RBCs on smears of the peripheral blood. In vivo, the immunoglobulin molecules cause an increased blood viscosity in a given packed RBC volume. The monoclonal IgM molecules in Waldenström macroglobulinemia are most likely to produce rouleaux formation along with large clusters of RBCs (called agglutination). (Reproduced, with permission, from Lichtman MA, Shafer MS, Felgar RE, Wang N. Lichtman's Atlas of Hematology. McGraw-Hill, 2016.) A micrograph of the blood smear from a case of plasma cell myeloma, reveals linear aggregates of red cells clumped in a rouleaux, or stacked, formation.

Current Medical Diagnosis & Treatment 2025 > Plasma Cell Myeloma

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eFigure 37–10. Morphologic characteristics of developmental stages of malarial parasites in the RBC. Note cytoplasmic Schüffner dots and enlarged host cells in Plasmodium vivax and Plasmodium ovale infections; the band-shaped trophozoite often seen in Plasmodium malariae infection; and the small, often multiply infected rings and the banana-shaped gametocytes in Plasmodium falciparum infections. Rings and gametocytes are typically seen in peripheral blood smears from patients with P falciparum infections. (Reproduced with permission from Goldsmith R, Heyneman D: Tropical Medicine and Parasitology. McGraw-Hill, 1989. © The McGraw-Hill Companies, Inc.) A table shows the first three parasitic stages of P vivax, P ovale, P malaria, and P falciparum. A table shows the last three parasitic stages of P vivax, P ovale, P malaria, and P falciparum.

Current Medical Diagnosis & Treatment 2025 > Malaria

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