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Figure 1. A 55-year-old woman with a past history of hepatitis C and chronic kidney disease was admitted to the hospital and reported to have excessive schistocytes on her peripheral smear, which is shown. As shown on the peripheral smear, the reported schistocytes are actually a peripheral smear artifact caused by proteinaceous precipitates (see arrows) deforming outer membrane of the erythrocytes. The patient was later found to have Type II cryoglobulinemia secondary to hepatits C infection. There was no evidence of cold agglutinin disease or hemolysis. To our knowledge, this is the first reported example of pseudo schistocytosis secondary to cryoglobulinemia. This case emphasizes the importance of a thorough review of the peripheral smear in making a diagnosis of schistocytosis.
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