Patient is a 7 week old who presented with a two week history of greater than 10 episodes per day of diarrhea. A CBC on admission revealed an H/H of 9.3/27, WBC of 1200/uL and platelet count of 32,000/uL. Serum ferritin was markedly elevated at 6250. A diagnosis of hematophagocytic lymphohistiocytosis (HLH) was made. An 18 week course of cyclosporine, dexamethasone and VP-16 was initiated with eventual full recovery. A number of abnormalities are seen on the peripheral smear including marked thrombocytopenia, mild anisocytosis and poikilocytosis with spherocytes, occasional fragmented RBCs and polychromatrophilic RBCs.