Dr Shanaz Khodaiji Consultant Hematopathologist P.D. Hinduja National Hospital & Medical Research Centre
A well made peripheral smear is thick at one end and progressively thinner at the opposite end. The "zone of morphology" (area of optimal thickness for light microscopic examination) should be at least 2 cm in length. The smear should occupy the central area of the slide and be margin-free at the edges
PBS examination requires a systematic approach in order to gather all possible information. In addition, all specimens must be evaluated in the same manner, to assure that consistent information is obtained.
(a) Ten microscopic fields are examined in a vertical direction from bottom to top or top to bottom (b) The slide is horizontally moved to the next field (c) Ten microscopic fields are counted vertically. (d) The procedure is repeated until 100 leukocytes have been counted
A WBC differential The identification of abnormal leukocytes Assessment of RBC morphology The number and morphology of the platelets The identification of intra- and extra-cellular elements Assessment of any organisms present
Microscopic examination of the peripheral blood is used to Hematology analyzers provide accurate quantitative In addition to providing cell counts and graphical displays The instrument operator reviews the information from each
specimen and decides if smear preparation and light microscopy are necessary.
can be obtained by counting the total number of leukocytes in ten 50X microscopic fields, dividing the total by 10, and multiplying by 3000. These estimates should approximate that obtained by the cell analyzer. If the estimate does not match the automated cell count, obtain the original blood specimen, confirm patient identity, repeat the automated analysis, and prepare a new smear.
Tanja Tornow
Thalassemia trait
Elliptocytes or ovalocytes
Ovalocytes are due to abnormal membrane cytoskeleton found in hereditary elliptocytoisis
"Thin" macrocyte
Tear drop shaped red cells or dacryocytes are seen when there is extramedullary erythropoiesis or with marrow disorders or marrow infiltration, such as myelofibrosis or metastatic carcinoma.
Polychromasia
Irregular, curved Hb S hemoglobinopathies (sickle cell cells with pointed anemia, hb SC disease, hb S-betaends thalassemia, hb SD disease, hb Memphis /S disease), other hemoglobinopathies (especially Hb I, Hb CHarlem, HbCCapetown).
Spherocytosis
Acanthocytes
Acanthocytes or spur cells, are spherical cells with blunt-tipped or club-shaped spicules of different lengths projecting from their surface at irregular intervals. (Echinocytes, or crenated red cells, in contrast, have shorter, sharp to blunt spicules of uniform length which are more evenly spaced around their periphery).
RBC with many tiny spicules (1030) evenly distributed over cell
Post-splenectomy, uremia, hepatitis of the newborn, malabsorption states, after administration of heparin, pyruvate kinase def phosphoglycerate kinase deficiency, uremia, HUS.
normal newborns bleeding peptic ulcer Aplastic Anemia pyruvate kinase def Vasculitis Glomerulonephritis renal graft rejection severe burns iron deficiency, thalassemia
DIC MAHA TP prosthetic heart valves severe valvular stenosis malignant hypertension march hemoglobinuria myelofibrosis hypersplenism
Uniconcave RBC, Hereditary or acquired hemolysis. slitlike area of central Hereditary stomatocytosis, alcoholic pallor cirrhosis, acute alcoholism, obstructive liver disease, malignancy, severe infection, treated acute leukemia, artifact.
G6PD deficiency Sex linked transmission Presents as hemolysis after drug intake, infections Common drugs antimalarials, acetanilide dapsone furantoin Lab diagnosis screening, quantitative tests Pyruvate kinase deficiency uncommon Lab diagnosis fluorescent spot test
RBC autoagglutination
Irregular RBC agglutination/ clumping Anti-RBC antibody, paraprotein. Cold agglutinin disease, autoimmune hemolytic anemia, macroglobulinemia, hypergammaglobinemia
Splenectomized patients, megaloblastic anema, severe hemolytic processes, hyposplenism, myelophthistic anemia.
WBC Morphology
Alder-Reilly anomaly
Large, coarse, dark purple, azurophilic granules that occur in the cytoplasm of most granulocytes. These are characteristically found in the Alder-Reilly anomaly and in patients with mucopolysaccharidoses
Chdiak-Higashi
Chdiak-Higashi granules are very large red or blue granules that appear in the cytoplasm of granulocytes, lymphocytes, or monocytes in patients with the ChdiakSteinbrinck-Higashi syndrome. It is a rare autosomal recessive disorder
Dhle bodies
Variably sized (0.1 to 2.0 um) and shaped, blue or grayishblue cytoplasmic inclusions usually found near the periphery of the cell. Dohle bodies are lamellar aggregates of rough endoplasmic reticulum, which appear in the neutrophils, bands, and metamyelocytes of patients with infection, burns, uncomplicated pregnancy, toxic states, or during treatment with hematologic growth factors - G-CSF.
May-Hegglin anomaly
Neutrophils contain small basophilic cytoplasmic granules which represent aggregated ribosomes. Leukopenia and large platelets are also found. An autosomal dominant trait, the May-Hegglin anomaly is associated with a mild bleeding tendency, but not by an increased susceptibility to infection
Platelet satellitism
Experience is required to make technically adequate smears. There is a non-uniform distribution of white blood cells over
the smear, with larger leukocytes concentrated near the edges and lymphocytes scattered throughout.
with small crowded red blood cells at the thick edge and large flat red blood cells without central pallor at the feathered edge
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