Typical blood findings in ATMDS. (A) Peripheral blood smear (May-Grünwald-Giemsa) from a patient with ATMDS who had not undergone transfusion. Many red blood cells are hypochromic or microcytic, but others appear relatively normal and well preserved, presumably the descendants of nonthalassemic clones. (B) Classic hemoglobin H (HbH) inclusions in a patient with ATMDS seen after supravital staining (brilliant cresyl blue). Images were visualized under a Zeiss upright optical microscope with Trinoc ocular unit (Carl Zeiss GmbH, Oberkochen, Germany) equipped with Zeiss 10 × ocular lenses and an Olympus C3000Zoom CCD 3.3 megapixel digital camera on a C-style mount (Olympus UK, Middlesex, United Kingdom). Digital images were transferred to an 800 MHz iBook computer with 12-inch video screen running OS 10.3.2 and iPhoto (Apple Computers, Cupertino, CA) and were processed with Adobe Photoshop 7.0 (Adobe Systems, San Jose, CA). Processing involved adjustments in image contrast, hue, and conversion from RGB to CMYK colorspace only; no other alterations were made. Figure 2A was viewed without a coverslip or immersion oil at 400 × total magnification, obtained using the ocular described above along with a Zeiss Plan 40 ×/0.75 objective lens. Figure 2B was viewed without a coverslip at 1000 × total magnification under a Zeiss Ph3 100 ×/1.25 oil immersion objective lens.