Blood Smear Interpretation

Blood smear interpretation
Theera Ruchutrakool, M.D.

Division of Hematology
Department of Medicine
Faculty of Medicine Siriraj Hospital
Mahidol University
Complete blood count are composed of
Automatic counting
History and physical examination are important and
informative
Smear interpretation skill are helpful in experience
hands
Smear interpretation skill
Guideline
Platelet
White cell
Red cell
platelet
low normal high
6 diseases WBC ET
low normal high
Agranulocytosis RBC Chronic

leukemia
Guideline
Platelet
Low platelet number
Aplastic anemia
Acute leukemia
Myelophthisis
ITP
TTP, HUS, DIC
Dengue hemorrhagic fever
platelet
low normal high
6 diseases WBC ET
low normal high

leukemia
Guideline
White cells
High chronic leukemia (CML, CLL)
Low agranulocytosis
Normal red cell disorders
platelet
low normal high
6 diseases WBC ET
low normal high

leukemia
Guideline
Red cells
Iron deficiency anemia
Hemolysis
Thalassemia
Spherocytosis: AIHA and HS
G-6-PD deficiency anemia with hemolysis
Microangiopathic hemolytic anemia
Blood smear tutorial
What is(are) the abnormality(ies) detected in this slide?

A. Spherocyte
B. Fragmented red cells
C. Hypochromic microcytic red cells
D. Thrombocytopenia
E. All of the above
What is the (most likely) diagnosis?

A. Thalassemia
B. Iron deficiency anemia
C. G-6-PD deficiency anemia
D. ITP
E. Autoimmune hemolytic anemia

A. Spherocyte
D. A and C
E. All of the above

A. Thalassemia
B. Iron deficiency anemia
D. Hereditary spherocytosis
E. Autoimmune hemolytic anemia

A. Spherocyte
C. Target cells
D. Basophilic strippling
E. All of the above

A. Iron deficiency anemia
B. G-6-PD deficiency anemia
C. Hereditary spherocytosis
D. Autoimmune hemolytic anemia
E. Hemoglobin H/Constant Spring
What is the name of this cell?

A. Spherocyte
B. Basophilic strippling
C. Target cells
D. Howell Jolly bodies
E. Nucleated red cell
This cell can be found in which of the following

Condition(s)?
A. Thalassemia
D. asplenia
E. All of the above

A. thrombocytopenia
B. Burr cells
C. Target cells
D. P.falciparum
E. All of the above

D. Autoimmune hemolytic anemia
E. Malaria

A. Spherocyte
C. Target cells
E. All of the above

D. Homozygous hemoglobin E
E. Hemoglobin H/Constant Spring

A. Spherocyte
B. Hemoglobin leakage cell
C. Target cells
E. Ring form P. falciparum

D. Homozygous hemoglobin E
E. Malaria
Hemoglobin leakage
cell
eccentrocytes

A. Spherocyte
B. Nucleated red cells (NRC)
C. Target cells
D. Fragmented red cells
E. All of the above
This cell can be found in which of the following

condition?
A. Thalassemia
D. asplenia
E. All of the above

A. Spherocyte
B. Hypochromic microcytic red cells
C. Polychromasia
D. Fragmented red cells
E. All of the above

B. Hereditary spherocytosis (HS)
D. Autoimmune hemolytic anemia (AIHA)
E. B and D

A. Spherocyte
B. Nucleated red cell
C. thrombocytopenia
D. Fragmented red blood cells
E. All of the above

A. Active SLE
B. DIC
C. TTP
D. HUS
E. All of the above

A. Acute promyelocytic leukemia (APL)
B. Chronic myeloid leukemia (CML)
C. Acute lymphoblastic leukemia (ALL)
D. Chronic lymphocytic laeukemia (CLL)
E. Who knows?

A. Acute non-lymphoblastic leukemia (ANLL)
B. Chronic myeloid leukemia (CML)
C. Acute lymphoblastic leukemia (ALL)
D. Chronic lymphocytic laeukemia (CLL)
E. Who knows?

A. Nucleated red cells
B. Tear drop cell
D. promyelocyte
E. All of the above
What is this finding?
A. Leukoerythroblastic blood picture
B. Acute leukemia
C. Myelophthisis
D. Shift to the left
E. A and C

A. Elevated plasma cells
B. Autoagglutination
C. Rouleaux formation
D. A and C
E. All of the above

A. Acute viral infection
B. Waldenstrom macroglobulinemia
C. Multiple myeloma (MM)
D. Chronic lymphocytic laeukemia (CLL) with
secondary AIHA
E. Who knows?

A. Elevated plasma cells
B. Autoagglutination
C. Rouleaux formation
D. A and C
E. All of the above

A. Acute viral infection
B. Waldenstrom macroglobulinemia
C. Multiple myeloma (MM)
D. Chronic lymphocytic laeukemia (CLL) with
secondary AIHA
E. Who knows?

A. Histiocytes
B. Pseudo-Gaucher cells
C. LE cells
D. Penicillosis
E. Who knows?
What is the name of these cells?

A. Malignant histiocytes
B. Adenocarcinoma cells
C. LE cells
D. PMN with toxic granules
E. Who knows?

A. Metastatic cancer
B. non-Hodgkin lymphoma, large cell type
C. Histoplasmosis
D. Megakaryocyte
E. Who knows?
1
2
What are the correct diagnosis (following in order)?

A. Histoplasmosis, mycobacteriosis and penicillosis
B. Penicillosis, mycobacteriosis and cryptococcosis
C. Histoplasmosis, mycobacteriosis and malaria
D. Penicillosis, mycobacteriosis and malaria
E. Who knows?
Spot diagnosis
What are the skin lesions found in these slides?

A. Panniculitis
B. Chloroma
C. Leukemia cutis
D. Livido reticularis
E. None of the above
Spot diagnosis
These lesion can be found in which of the following

disease?
A. Acute myeloblastic leukemia
B. Acute monoblastic leukemia
C. Acute promyelocytic leukemia
D. Acute lymphoblastic leukemia
Spot diagnosis
Gum hypertrophy can be found in which of the

following disease(s)?
B. Acute monoblastic leukemia
C. Acute promyelocytic leukemia
D. Acute lymphoblastic leukemia
E. All of the above
Spot diagnosis
Bilateral tonsil enlargement can be found in which of

the following disease(s)?
B. NHL
C. HD
D. CA tonsil
E. All of the above
Spot diagnosis
Digital gangrene can be found in which of the

A. Vasculitis
B. Essential thrombocytosis
C. Antiphospholipid syndrome
D. All of the above
Spot diagnosis
Unilateral exophthalmos can be found in which of the

A. Acute monoblastic leukemia
B. NHL
C. Hyperthyriodism
D. All of the above
Spot diagnosis
Exfoliative dermatitis can be found in which of the

A. Drug allergy
B. NHL
C. Uncontrolled primary skin diseases
D. All of the above
Spot diagnosis
Generalized osteolytic lesions can be found in which

of the following disease(s)?
A. MGUS
B. Smoldering multiple myeloma
C. Multiple myeloma
D. All of the above
Spot diagnosis
Macroglossia can be found in which of the

following disease?
B. Acute lymphoblastic leukemia
C. Multiple myeloma
D. amyloidosis
Spot diagnosis
What is the name of this lesion?

A. Ecthyma gangrenosum
B. Pyoderma gangrenosum
C. Eschar
D. Hemorrhagic bleb
Spot diagnosis
What is the name of the lesion?

A. Esophageal cancer
B. Esophageal web
C. Esophageal spasm
D. Esophageal reflux
Spot diagnosis
The pathology can be found in which of the following

condition?
B. Megaloblastic anemia
C. Aplastic anemia
D. Systemis sclerosis
Spot diagnosis
Which is the most likely diagnosis?

B. Megaloblastic anemia
C. Aplastic anemia
D. Myelodysplastic syndrome
Spot diagnosis
Huge splenomegaly can be found in which of the

A. Tropical splenomegaly
B. Chronic myeloid leukemia
C. Beta thalassemia/ HbE disease
D. Agnogenic myeloid metaplasia
E. All of the above
Spot diagnosis
Facial diplegia can be found in which of the following

Disease(s)?
A. Acute lymphoblastic leukemia
B. GBS
C. All of the above
D. None of the above
Spot diagnosis
SVC obstruction can be found in which of the

A. Acute lymphoblastic leukemia
B. Germ cell tumor
C. NHL-lymphoblastic
D. All of the above
E. All of the above
Thank you for your attention

Blood Smear Interpretation

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Blood Smear Interpretation

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Blood smear interpretation

Theera Ruchutrakool, M.D.

low normal high

low normal high

Agranulocytosis RBC Chronic

low normal high

low normal high

Agranulocytosis RBC Chronic

low normal high

low normal high

Agranulocytosis RBC Chronic

What is(are) the abnormality(ies) detected in this slide?

What is the (most likely) diagnosis?

What is(are) the abnormality(ies) detected in this slide?

What is the (most likely) diagnosis?

What is(are) the abnormality(ies) detected in this slide?

What is the (most likely) diagnosis?

What is the name of this cell?

This cell can be found in which of the following

What is(are) the abnormality(ies) detected in this slide?

What is the (most likely) diagnosis?

What is(are) the abnormality(ies) detected in this slide?

What is the (most likely) diagnosis?

What is(are) the abnormality(ies) detected in this slide?

What is the (most likely) diagnosis?

What is(are) the abnormality(ies) detected in this slide?

This cell can be found in which of the following

What is(are) the abnormality(ies) detected in this slide?

What is the (most likely) diagnosis?

What is(are) the abnormality(ies) detected in this slide?

What is the (most likely) diagnosis?

What is the (most likely) diagnosis?

What is the (most likely) diagnosis?

What is(are) the abnormality(ies) detected in this slide?

What is(are) the abnormality(ies) detected in this slide?

What is the (most likely) diagnosis?

What is(are) the abnormality(ies) detected in this slide?

What is the (most likely) diagnosis?

What is the name of this cell?

What is the name of these cells?

What is the name of this cell?

What are the correct diagnosis (following in order)?

What are the skin lesions found in these slides?

These lesion can be found in which of the following

Gum hypertrophy can be found in which of the

Bilateral tonsil enlargement can be found in which of

Digital gangrene can be found in which of the

Unilateral exophthalmos can be found in which of the

Exfoliative dermatitis can be found in which of the

Generalized osteolytic lesions can be found in which

Macroglossia can be found in which of the

What is the name of this lesion?

What is the name of the lesion?

The pathology can be found in which of the following

Which is the most likely diagnosis?

Huge splenomegaly can be found in which of the

Facial diplegia can be found in which of the following

SVC obstruction can be found in which of the

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