On a blood smear of a patient with intravascular hemolysis, you would expect to find which fragments?

• A. Spherocytes
• B. Target cells
• C. Schistocytes
• D. Basophilic stippling

Answer: (C)

Intravascular hemolysis involves red cells being destroyed within the bloodstream, so the smear shows fragmented red cells called schistocytes. These fragments result from mechanical shearing as cells pass through damaged microvasculature or artificial/obstructed vessels, producing irregular helmet-shaped pieces. This pattern is a hallmark of intravascular or microangiopathic hemolysis, such as in DIC, TTP/HUS, or with prosthetic heart valves.

Spherocytes arise from loss of membrane without fragmentation, typical of extravascular hemolysis or hereditary spherocytosis, and thus aren’t the fragments seen with intravascular destruction. Target cells reflect altered membrane-to-volume ratio seen in liver disease, thalassemia, or after splenectomy, not fragmentation. Basophilic stippling shows ribosomal RNA aggregates in certain anemias like lead poisoning or sideroblastic anemia, not hemolytic fragmentation. Therefore the expected fragments in this scenario are schistocytes.