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Blood Film

Erythrocytes Classification of Poikilocytes

Round Elongated Spiculated
Spherocytes Ovalocytes/ elliptocytes Schistocytes
Stomatocytes Teardrop cells Keratocytes
Target cells Sickle cells Echinocytes
Hb C crystalloids Acanthocytes
HB S-C hybrids

Anisocytosis Dimorphic RBC

RDW = Red cell Distribution Width IDA patient transfused/ treated with
IDA - ↑ RDW iron
Thalassemia – Normal RDW Sideroblastic Anemias

Tear-drop cells Rouleaux

Occur when Plasma protein
concentration ↑ (cause ↑ ESR)
Conditions
Erythroblasts Howell Jolly Body • Infections
Found in BM Nuclear remnants • Inflammatory disorders
Normally removed/ pitted by spleen • CT disorders
Appear in peripherals in • Cancers
Hyposplenism Diagnosis - Multiple myeloma
(plasma cell seen on film)

Hypersegmented Neutrophils
Deficiencies in B12, Folic acid
Uremia
2° to Drugs
Hypochromasia
Microcytosis/ Hypochromia
IDA Schistocytes/ Fragmented RBC Sickle cells
Thalassemia Causes Sickle Cell Anaemia
Anemia of chronic disease • Mechanical heart valve HbS forms linear ‘tactoids’
(dysfun ctional) Reversible (initially) → Irreversible
• Hemolytic Uremic Syndrome Removed in RES/ stuck in small blood
(HUS) vessels (obstruction)
• Thrombotic Thromb ocytopenic Sickling → Infarction
Purpura (TTP) Frequently hyposplenic (nucleus not
• Disseminated Intravascular removed rapidly)
Coagulation (DIC)

Macrocytosis Normal RBC

Target cells
Center containing Hb
Periphery Hb
Microangiopathy/ Schistocytes
Causes
Red cell fragments
MAHA – Microangiopathic Hemolytic • Hemoglobinopathy
Anaemia • Liver disease
If Howell-Jolly Body present also,
Causes
• Mechanical heart valve • Hyposplenism
(abnormal fun ction) • Splenectomy
• Hemolytic uremic syndrome
(HUS)
• Thrombotic thrombocytopenic
purpura (TTP)
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Leukoerythroblastic Bl ood Pi cture Investigations

Serum Iron
Iron deficiency
Infections
Inflammations
Malignant disease
Serum Transferrin (Same as TIBC)
↑ in Iron deficiency
↓ in Infections, Infla mmations, Malignant disease
Serum Ferritin
Presence of Reflect Total Iron Body Stores (except – liver disease, acute inflammation)
• Primitive red cells (nucleated Serum Vitamin B12
RBC, RBC) Vitamin B12 deficiency
• Primitive white cells Serum & Erythrocyte Folate
(myelocytes) Folate status
Indicate BM infiltrated/ replaced Direct & Indirect Bilirubin
• 2° Cancer Indirect (unconjugated) – Does not appear in urine
• Fibrosis Direct - ↑ load of bilirubin, Hepatocellular dysfunction
Serum Haptoglobulin (Heme binding protein)
Blast cells (immature precursor of lymphoblasts, myeloblasts) ↓ level indicate – Hemolysis (any cause), Liver cell failure (↓ synthesis)
Bone Marrow Aspirate & Biopsy
Leukaemia
2° Cancer
Myeloma
Hb Electrophoresis
Diagnose Haemoglobinopathy

Blast cells
Do not normally appear in peripheral
If appear, signify Acute Leukemia
Auer Rod – Acute Myeloid Leukemia

Neutrophils

Band cells / band neutrophils Left Shift

Unsegmented nuclei Neutrophils in blood slightly earlier
↑ bands in periph. blood = left shift stage of maturation (Band cells)
Dohle bodies
Severe infection
Severe hypoxia, shock

Metamyelocyte

Metamyelocyte
Normal stage in maturation of
granulocytes (seen only in BM)
If in peripheral blood (left-shift ) , can
be due to Infection, Marrow Stress