Blasts and Normoblasts in Blood Smear with Leukopenia

A clinical case of blasts and normoblasts in a peripheral blood smear with leukopenia (3.02×10⁹/L). Microscopy features and differential count.

Tanya Stepanova 1 min March 7, 2026

Blood smear: blast cell with delicate chromatin in the center of the field of view

Blood smear: blast with high nuclear-cytoplasmic ratio

Blood smear: blast cell with a round nucleus in a smear with leukopenia

Blood smear: atypical blast in the field of view with altered erythrocytes

Blood smear: blast cell in a peripheral blood smear

Blood smear: blast with a narrow rim of cytoplasm under microscopy

Blood smear: mononuclear blast cell in a patient's smear

Blood smear: normoblast with a dense round nucleus among erythrocytes

End of the working day (or rather, 3 minutes before leaving). Microscopes are turned off, immersion oil wiped from the objective, time to go home.🥳

Then the on-duty lab assistant runs in, a smear in hand, a “puppy dog” look on her face.😥

👉🏻Patient’s smear. Leukocytes 3.02 10^9 🤔My thoughts: “Leukopenia, but we’ll quickly sort out the cells.” Spoiler: I’ve never been so wrong.🥲

Upon reviewing the smear, normoblasts are encountered (photo 8). A total of 34 per 100 leukocytes. Thus, with leukopenia and an increased normoblast count, it is impossible to limit oneself to reviewing just one slide. Blasts were also found in the smear (photos 1-7).

❌The plan to leave work on time was thwarted.

❓Would you agree to count the smear or leave it to the on-duty shift of lab assistants?

🙏 The publication was kindly provided by Clinical Laboratory Diagnostics Doctor Tanya Stepanova, Volgograd