Intravascular hemolysis due to Clostridium perfringens sepsis

This is a peripheral blood smear from a patient with severe intravascular hemolysis due to sepsis with Clostridium perfringens. Neutrophils show toxic changes, including toxic granulation and vacuoles. There is an increased number of spherocytes (blue arrows) and polychromatophilic red cells (ie, reticulocytes [red arrow]). The major finding on this slide is the large number of red blood cell ghosts (black arrows), due to the intravascular lysis of red cells from the phospholipase and other lytic enzymes elaborated by the clostridial organisms.