The image corresponds to a 32 years old male diagnosed with heart paravalvular leak with increasing severity during the last six months. He presented clinical signs that were compatible with anemia of two weeks of history, increased indirect bilirubin (1.93 mg/dL),  lactate dehydrogenase (3566 U/L), and low haptoglobin levels.The complete blood count showed hemoglobin of 8.2 g/dl (normocytic normochromic anemia), increased red cells distribution width, platelets 296000/ml, and leukocytes in normal ranges. Peripheral blood smear revealed schistocytes (+++), echinocytes (+++), and polychromatic macrocytes, which resemble reticulocytes. In the context of the valvulopathy described, these findings suggest mechanical hemolytic anemia.