She appears pale, and her pulse rate is increased. It is slightly larger than a normal red cell. Sometimes it is difficult to distinguish small lymphocytes from nucleated red blood cells in blood smear preparations. There is a slight rim of basophilic cytoplasm, in contrast to the polychromatophilic staining of the NRBC cytoplasm.
Spherocytes appear smaller than biconcave red cells and lack central pallor.
The presence of many spherocytes and increased polychromasia in the peripheral blood smear suggests the possibility of an immune hemolytic anemia. A high RDW is typical in immune hemolytic anemias. In the context of an immune hemolytic anemia the presence of increased polychromasia and NRBCs indicates that the bone marrow is responding to the anemia by increasing red blood cell production. Some early red cell precursors are released prematurely from the bone marrow. All referees and 89.