In disseminated intravascular coagulation, what smear finding is commonly observed?

• A. Spherocytes due to membrane loss.
• B. Target cells.
• C. Schistocytes due to microangiopathic hemolysis.
• D. Burr cells.

Answer: (C)

In disseminated intravascular coagulation, widespread activation of coagulation creates fibrin strands and microthrombi in small vessels. Red blood cells passing through these narrowed, fibrin-rich vessels are mechanically damaged, leading to fragmented cells known as schistocytes (helmet cells). This microangiopathic hemolysis is the hallmark smear finding in DIC. Other smear patterns don’t fit: spherocytes arise from membrane loss in conditions like hereditary spherocytosis or autoimmune hemolytic anemia; target cells appear in liver disease and certain hemoglobinopathies; burr cells occur in uremia and other contexts.