Autoimmune hemolytic anemia is relatively common in CLL patients and is a reflection of autoimmune abnormalities frequently seen in these patients. This patient had history of stable chronic lymphocytic leukemia and presented with accelerated drop in hemoglobin. Corrected reticluocyte count was over 7%. The peripheral blood smear shows spherocytes and numerous small mature lymphocytes typical of CLL. A smudge cell in present just to the left of center of the image. Image courtesy of: Ed Uthman, MD, Houston, Texas.