Optical and scanning electron microscopy (SEM) of red blood cells (RBCs) of common carp, Cyprinus carpio, inhabiting a polluted lake in Northeast India revealed a number of abnormalities. About 7% of the RBC showed the presence of a micronucleus, besides the presence of some bi-nucleated and abnormally shaped nuclei. RBCs, white blood cells, and hemoglobin content were found to be reduced significantly as compared to the control. SEM showed the presence of spherocytes, early stages of echinocytes, cytoplasmic blebbing, erythrocytes with contraction from one side, abnormal shape of erythrocytes (hexagonal/pentagonal/tetragonal), development of lobopodial projections, cell rupture, membrane internalization, and formation of ring-shaped RBC. Energy dispersive X-ray spectroscopy (EDS) showed the presence of a considerable percentage of silicon and lead in erythrocytes of the fish collected from the polluted lake, in contrast to a negligible concentration of the two elements in control fish. Significance of the study in relation to fish health in a polluted body of water and the importance of SEM, EDS, and light microscopy in utilizing hematological parameters as pollution indicators are discussed.