A 65-year-old man with anemia: diagnosis with peripheral blood smear

which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. A 65-year-old man presented with a 5-day history of fever. He took an antimalarial drug (Fansidar;sulfadoxine/ pyrimethamine) without being tested for malarial parasite. and corrected reticulocyte count, 20%. Peripheral blood smear (PBS) displayed numerous blister cells (black arrow) and other hemolytic features such as spherocytes (blue arrow), polychromasia (yellow arrow), nucleated red blood cell (green arrow), and Howell-Jolly body (A, pink arrow). Reticulocyte preparation revealed Heinz bodies (B, orange arrow). Acanthocytes (red arrow) signifies acute renal injury. Further workup showed the following: total bilirubin, G6PD level measured after 8 weeks was 0.2 U/gHb He had no similar episode in the past. Urinary pseudomonas isolates was the likely cause of the fever. According to the PBS findings and low G6PD levels, we made a diagnosis of G6PD deficiency, which is an X-linked hereditary disease characterized by low levels of G6PD, a metabolic enzyme involved in the pentose phosphate pathway. Antimalarials usually induce acute hemolysis in G6PD-deficient individuals. Late presentation is not uncommon, where peripheral smear can be useful in diagnosis without medical or family history.