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Teardrop cells in a peripheral blood smear from a patient whose bone marrow was extensively replaced by B lymphoblastic leukemia. Teardrop cells may be seen in the setting of marrow infiltration (by fibrosis, granulomatous inflammation, hematologic or metastatic malignancy), splenic abnormalities, megaloblastic anemia, and thalassemia. True teardrop cells have slighly rounded or blunted ends. In contrast, teardrop cells that are formed as an artifact of smear preparation have very sharp points, all facing in the same direction.