Which peripheral smear findings are typical in thalassemia major and intermedia?

• A. Microcytosis with target cells and hypochromia; nucleated red blood cells may be present.
• B. Macrocytosis with hypersegmented neutrophils.
• C. Spherocytes and schistocytes.
• D. Giant platelets and increased mean platelet volume.

Answer: (A)

In thalassemia major and intermedia, red blood cells are small and pale because globin synthesis is reduced. This leads to microcytosis and hypochromia on the smear. You’ll often see target cells as a result of the altered red cell membrane to hemoglobin ratio, and nucleated red blood cells may appear when the bone marrow aggressively expands to compensate for anemia. This combination—microcytosis with hypochromia, possible target cells, and occasional nucleated RBCs—supports thalassemia as the underlying pattern.

Other smear patterns point to different problems. Macrocytosis with hypersegmented neutrophils suggests megaloblastic anemia from B12 or folate deficiency. Spherocytes and schistocytes indicate membrane or fragmentation hemolysis (such as hereditary spherocytosis or microangiopathic processes). Giant platelets with increased mean platelet volume point to platelet production issues or certain platelet disorders. The microcytic, hypochromic picture with target cells and potential nucleated RBCs best fits thalassemia major and intermedia.