The peripheral smear illustrated in the photograph was obtained from a patient with a recent renal transplant.

The patient developed a rash, accompanied by nausea and diarrhea.

• Graft vs. host disease was clinically suspected.
• The peripheral smear findings are consistent with that diagnosis.
• The presence of spherocytes suggests a hemolytic process which is supported by the presence of nucleated RBCs.
• A few scattered schistocytes and the decrease of platelets suggests DIC.
• The presence of target cells presents the possibility of associated liver disease.
• Additional tests, particularly coagulation studies, should confirm the diagnosis of microangiopathic hemolytic anemia.