Common abnormalities in Blood Smear examination

  • Anisocytosis
    Variation in the size of RBC seen in Fe deficiency anemia, megaloblastic anemia, and sideroblastic anemia
  • Poikilocytosis
    Variation in the shape of RBC, seen in Fe deficiency anemia, thalassemia, and sideroblastic anemia.
  • Microcytosis
    RBC size less than normal (< 75 fL), seen in Fe deficiency anemia, thalassemia, and sideroblastic anemia
  • Macrocytosis 

size of RBC> 100 fL seen in vitamin B12 and also folic acid deficiency

  • Hypochromia 

RBC with less Hb, the increased central pallor is seen in Iron deficiency anemia, thalassemia, sideroblastic anemia

  • Basophilic stippling or punctate basophilia

Presence of scattered deep blue dots in the cytoplasm of RBC with Romanowsky staining, seen in pathologically damaged young red cells, severe anemia β thalassemia, and chronic lead poisoning.
  • Target cells—Flat red cells with a central mass of Hb (dense area) surrounded by a ring of pallor (pale area) and an outer ring of Hb (dense area), seen in chronic liver diseases, hyposplenism, and hemoglobinopathies.
  • Howell-Jolly bodies—seen in non-functioning or absent spleen and megaloblastic anemia.
  • Heinz’s bodies (Ehrlich’s bodies)—formed from denatured, aggregated hemoglobin, seen in thalassemia, hemolytic anemia due to G6PD deficiency, asplenia, and chronic liver disase.
  • Burn cells—RBC showing regularly placed spicules, seen in uremia.
  • Schistocytes—they are fragmented RBCs seen in intravascular bemolysis.


  • Spherocytes—small, densely packed RBCs with loss of central pallor, seen in hereditary spherocytosis and immunohemolytic anemias.

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