Basophilic stippling of red cells in lead poisoning

Peripheral blood smear shows basophilic stippling in several red cells from a patient with lead poisoning. The granules represent ribosomal precipitates. Other causes of basophilic stippling include:

• Thalassemia
• Megaloblastic anemia
• Sickle cell disease
• Sideroblastic anemia
• Heavy alcohol use
• Lead and other heavy metal poisoning
• Pyrimidine 5'-nucleotidase (P5N) deficiency

High-power view of a normal peripheral blood smear. Several platelets (arrowheads) and a normal lymphocyte (arrow) can also be seen. The red cells are of relatively uniform size and shape. The diameter of the normal red cell should approximate that of the nucleus of the small lymphocyte; central pallor (dashed arrow) should equal one-third of its diameter.