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The page below is a sample from the LabCE course Body Fluid Differential Tutorial. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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The heavy black pigmentation indicated by the arrow in the macrophages in this image is hemosiderin - a storage form of recycled iron. This is a bronchoalveolar lavage (BAL) sample from a patient that had pneumonia-like symptoms with two episodes of unexplained drops in hemoglobin without obvious external bleeding.

The large amount of hemosiderin is a reflection of the amount of intra-alveolar bleeding that was causing both the drop in hemoglobin and the pneumonia symptoms.