BLOOD FILMSNormal Blood FilmHigh power view of a normal peripheral blood smear.

Several platelets (black arrows) and a normal

lymphocyte (blue arrow) can also be seen. The red cells are of relatively uniform size and shape.
The diameter of the normal red cell should approximate that of the nucleus of the small lymphocyte;
central pallor (red arrow) should equal one-third of its diameter.

Beta-thalassaemia traitPeripheral smear from a patient with beta thalassemia trait. The field shows numerous hypochromic
and microcytic red cells (thin arrows), some of which are also target cells (blue arrows). Courtesy of
Stanley Schrier, MD

Sickle Cell anaemiaPeripheral smear from a patient with sickle cell anemia shows multiple spindly sickle cells (blue
arrows), a nucleated red blood cell in the upper left, and a Howell-Jolly body (black arrow), which
is a nuclear fragment normally removed by the spleen. Target cells are also present (red arrow). This
patient has functional asplenia because of repeated splenic infarctions.

Howell-Jolly bodiesThis peripheral blood smear shows Howell-Jolly bodies in two red cells (black arrows), nuclear
remnants that are normally removed by the spleen. Thus, they are seen in patients who have
undergone splenectomy (as in this case) or have functional asplenia (eg, sickle disease disease).
Target cells are also seen (blue arrows), another consequence of splenectomy.

Hemolytic Anemias, Characterized by Different Types of PoikilocytesThe blood smear shows hereditary elliptocytosis, with numerous elliptocytes and smaller
numbers of ovalocytes

Shows hereditary pyropoikilocytosis; there is striking poikilocytosis, with elliptocytes,

ovalocytes, and fragments.

Shows microangiopathic hemolytic anemia resulting from cyclosporine therapy,

with numerous red-cell fragments. All specimens were stained with MayGrnwaldGiemsa
stain.

Figure 2. Red-Cell Changes in Various Types of Hemolytic Anemia.

The blood smear in Panel A depicts acute hemolysis in glucose-6-phosphate dehydrogenase
(G6PD) deficiency, with the presence of a bite cell, or keratocyte (arrow).

Figure 2. Red-Cell Changes in Various Types of Hemolytic Anemia.

Panel B shows acute hemolysis in G6PD deficiency, with two blister cells (arrows), as well as
polychromatic macrocytes and irregularly contracted cells (arrowheads).

Figure 2. Red-Cell Changes in Various Types of Hemolytic Anemia.

In Panel C, hereditary spherocytosis is characterized by numerous spherocytes
(hyperchromatic cells with a regular outline).

Figure 2. Red-Cell Changes in Various Types of Hemolytic Anemia.

Panel D shows paroxysmal cold hemoglobinuria, with erythrophagocytosis; the arrow points
to a red cell that has been phagocytosed by a neutrophil. All specimens were stained with
MayGrnwaldGiemsa stain.

Figure 3. Red-Cell Changes in Various Types of Macrocytic Anemia.

Pernicious anemia is shown in the blood smear in Panel A, with anisocytosis, macrocytosis,
and a hypersegmented neutrophil.

Figure 5. Blood-Smear Features Associated with Thrombocytopenia and Errors in the Platelet
Count. Panel A shows large clumps of platelets that led to a factitiously low platelet count.
Panel B demonstrates platelet satellitism.

Figure 6. Miscellaneous Conditions in Which the Blood Smear Can Be Diagnostically

Important.Panel A shows Burkitts lymphoma, with three basophilic vacuolated lymphoma
cells

Figure 6. Miscellaneous Conditions in Which the Blood Smear Can Be Diagnostically

Important. Panel B, with two characteristic bilobed leukemic promyelocytes.

Figure 6. Miscellaneous Conditions in Which the Blood Smear Can Be Diagnostically

Important. Panel D shows target cells (short arrow), acanthocytes (long arrow), and a
HowellJolly body (arrowhead) all features of hyposplenism in a blood smear
from a patient with iron-deficiency anemia and splenic atrophy as features of celiac disease.
All specimens were stained with MayGrnwaldGiemsa stain

Source- NEJM Blood Films. August 4, 2005.