A 63-year-old man, without any significant previous medical or surgical history, presented to the Internal Medicine service with a1-month history of generalized weakness, back pain, and repeated episodes of epistaxis. He was a farmer. In physical examination, vital signs were stable and the patient was mildly drowsy. Table 1 shows complete blood count (CBC) analysis and biochemical workup. Due the patient's anemia, a peripheral blood smear (PBS) was made (Fig. 1; Panel A).