The page below is a sample from the LabCE course Red Cell Disorders: Peripheral Blood Clues to Nonneoplastic Conditions. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Case Study
A five-month-old Asian child is brought to the pediatrician by her mother who is concerned because the child is not eating well. Upon examination, it is noted that the child's spleen is palpable. A CBC and reticulocyte count are ordered, and the results are shown below. A Wright-stained peripheral blood smear is also reviewed. A representative microscopic field from that smear is shown on the right.
These blood count results were reported:
ParameterPatient ResultReference Interval
RBC5.5 x 1012/L3.1 - 4.5 x 1012/L
Hgb9.6 g/dL9.5 - 13.5 g/dL
HCT30.4%29- 41%
MCV55.4 fl74 - 108 fl
MCH17.5 pg25 - 35 pg
MCHC31.6 g/dL30 - 36 g/dL
RDW34.9%11 - 15%
Reticulocyte10.9%0.5 - 4.0%

Knowing that the family is from a region of Thailand where HbE carriers are prevalent, the physician orders a hemoglobin electrophoresis, which detects HbE.
The blood count results and peripheral blood smear results also provided clues to the eventual diagnosis of Hgb E/beta thalassemia. Which of the following RBC morphologies are present in this microscopic field?

More than one answer is correct. Please select all correct answers