An 18-year-old man with no past medical history presented to an outside hospital with acute respiratory distress syndrome complicating a previously undiagnosed interstitial lung disease. While awaiting transplant at our institution, his course was complicated by numerous infections and right-sided heart failure requiring extracorporeal membrane oxygenation. In the week prior to his expiry, the patient had sepsis which was culture positive for multidrug-resistant Klebsiella pneumoniae, Pseudomonas aeruginosa, and Enterococcus faecalis. Hematopathologist slide review noted bacterial rods, neutrophil inclusions, and hypo- and hyperlobated neutrophils (panel A; original magnification ×1000 [oil immersion], Wright-Giemsa stain, for both panels). Marked leukoerythroblastosis was present with erythroid dyspoiesis consisting primarily of erythroid nuclear abnormalities (panel B). Corresponding blood count demonstrated hemoglobin of 10.1 g/dL, platelets of 9 × 10 9/L, white cell count of 25.20 × 10 9/L with 91% neutrophils, and nucleated red cells representing 35% of nucleated cells.Despite continued antibiotic therapy, the patient died shortly afterward. Hemolysis, both a known cause of stress dyspoiesis and a known complication of both sepsis and extracorporeal membrane oxygenation, was present as evidenced by decreased haptoglobin (<10 mg/dL) and increased plasma hemoglobin (up to 7.49 g/L). Other potential causes of dyspoiesis (medication, toxin, artifact) were not identified in the current case. This case highlights the level of stress dyspoiesis that may be seen in reactive situations.