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Peripheral Smear

A microscopic examination of a stained, peripheral blood smear may be useful in evaluating blood disorders.


  • These are abnormal in size

Basophilic Stippling

  • Usually seen in reticulocytes, an immature form of RBC, released in response to strong stimulus, and seen in:
    • Anemia
    • Leukemia
  • Is nearly universally seen in cases of clinically significant lead poisoning.


  • The normally pale center of the RBC is even more pale, suggesting reduced concentrations of hemoglobin within the cell.

Malarial Stippling

  • Very fine granular appearance to the RBCs, representing malarial parasites.
  • Also known as:
    • Schueffner's dots
    • Parasitized RBCs


  • Normal amounts of staining for hemoglobin, suggesting normal concentrations of hemoglobin within the cell.

Nucleated RBCs

  • In an adult, RBCs are not normally nucleated. 
  • The presence of NRBCs indicates the body is aggressively producing red cells and releasing them into the circulation prior to full maturity. 
  • This is commonly seen in cases of significant anemia.


  • These are abnormal in shape.
  • This due to improper formation of the cell membrane.
  • This typically occurs in cases of severe anemia when the RBC manufacturing system goes into overdrive, greatly increasing the number of RBCs produced, but with lesser degrees of quality control.


  • Variations in staining of the RBC suggesting a more rapid production than is usually seen. 
  • Commonly seen in anemias of all types, but particularly hemolytic anemias and anemias following acute blood loss.


  • An immature form of RBC, it released in response to strong stimulus, and seen in:
    • Anemia
    • Leukemia


  • Bizarre-shaped RBCs, resembling triangles or spirals.
  • Associated with:
    • Severe burns
    • DIC
    • Artificial heart valves
    • Vascular spasm

Sickle Cells

  • Crescent-shaped RBCs, associated with abnormal hemoglobin formation (Hemoglobin S, SS, SC, SD or Sickle-Thallasemia.)
  • Associated with hemolytic anemia.


  • Smaller and rounder than normal RBCs
  • Associated with:
    • Hereditary disease
    • Post-transfusion changes
    • Water dilution

Target Cells

  • Smaller than normal RBCs, with a central concentration of hemoglobin, giving it the appearance of a target.
  • Associated with:
    • Liver disease
    • Iron deficiency anemia
    • Thallesemia

Normal Values of the Peripheral Smear*

Size Normocytic (7-8 µm)
Color Normochromic
Shape Normocyte 
Structure No nucleated cells

*These are general values taken from a variety of sources. The actual normal values may vary from lab to lab and from one type of testing protocol to another.

Source: Operational Medicine 2001,  Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300