Normal Values:

Red cells normally are the same in size and color and have a lighter-colored area in the center. The blood smear is considered normal if there is:

• Normal differential
• Normal appearance of cells

What abnormal results mean:

Abnormal results mean there is an abnormalities in the size, shape, coloring or coating of the red blood cells.

Some abnormalities may be graded on a 4-point scale:

• 1+ means 25% of cells affected
• 2+ means half of cellsare affected
• 3+ means 75% of cells are affected
• 4+ means all of the cells are affected

The presence of target cells may be due to:

• Decreased osmotic fragility
• Deficiency of an enzyme called lecithin cholesterol acyl transferase
• Liver disease (especially obstructive jaundice)
• Hemoglobin abnormalities (hemoglobinopathies)
• Iron deficiency
• Spleen removal
• Thalassemia

• Autoimmune hemolytic anemia
• Hereditary spherocytosis
• Increased osmotic fragility

The presence of elliptocytes may be a sign of hereditary elliptocytosis.

The presence of fragmented cells (schistocytes) may be due to:

• Microangiopathic hemolytic anemia
• Disseminated intravascular coagulation
• Thrombotic thrombocytopenic purpura (TTP)
• Artificial heart valve (aortic valve prosthesis)
• Hemolytic uremic syndrome (HUS)

The presence of a type of immature red blood cell called a normoblast may be due to:

• Cancer that has spread to bone marrow
• Erythroblastosis fetalis
• Leukoerythroblastic anemia (myelophthisis process)
• Miliary tuberculosis
• Myelofibrosis
• Removal of spleen
• Severe hemolysis
• Thalassemia

• Uremia

• Abetalipoproteinemia
• Severe liver disease

• Myelofibrosis
• Leukoerythroblastic anemia
• Thalassemia major
• Severe iron deficiency

• Post-splenectomy
• Sickle cell anemia
• Myelodysplasia

• G6PD deficiency
• Congenital hemolytic anemia
• Unstable form of hemoglobin (unstable hemoglobin variant)
• Alpha thalassemia

The presence of reticulocytes (more than 2% of total red cells; seen with special stain) may indicate hemolytic anemia or hemorrhage.

The presence of basophilic stippling may indicate:

• Myelofibrosis
• Myelophthisic process
• Lead poisoning

The presence of sickle cells may indicate sickle cell anemia.