How to look at A peripheral blood smear
How to look at A peripheral blood smear
Low Power 1 - Scan the slide under low power (10 x) 2 - Find a good area 3 - Evaluate red cell distribution 4 - Evaluate the white count 1 WBC = 1000 -2000 mm 3
Too thick area Red cells appear as; • microcyte • hypochrome • rouleaux
Too thick area
Too thin Red cells appear as • macrocyte • spherocyte • poikilocyte
Too thin area
Good area
What are you looking for at a peripheral smear (Oil immersion) • • Red cell morphology Platelet number and morphology WBC differential and morphology Blood parasite
RBC MORPHOLOGY
r lo Co n io ut rib st Di n o i s u l Inc Sh ap e ze i S
Evaluate red cells for size
Normocytes
Microcytes
Macrocytes
Macro-ovalocytes
Anisocytosis
Hb content & distribution
Normochrome
Hypochrome
spherocyte
Microspherocyte
Dimorphic population
Target cells
Stomatocytes
shape
Normocyte
Tear-drop cells
Acanthocytes
Echinocytes
Ovalocyte - Elliptocyte
Sickle cells
Keratocyte (Horn cell)
Pincher cells
Schistocytes
Distribution
Erythrocyte antibody rosetting (EA-rosetting)
Rouleaux formation
Inclusions
Hb. H(Golf ball)
Hb. C crystal
Basophilic stippling
Howell Jolly bodies
Pappenheimer bodies
Cabot ring
babesia
Nucleated red blood cell (NRBC)
Beware of artifacts! 1) Water spots 2) Precipitated stain 3) Aged RBC 4) Refractiles
Refractiles: o Humidity; under-fixation o late fixation o presence of water in alcohol used o excess buffer to stain o thick smear
Refractiles: Increased central pallor but a normal thick rim of Hb.
Artifact(water spots)
Precipitated stain
Reference guide for grading red blood cell morphology Normal < 5 27 -34 pg < 3 80 -100 fl 0 <6 0 <5 0 RBC type Hypochromia Polychromasia Microcytes Macrocytes Schistocytes Elliptocytes Rouleaux Spherocytes Target cells Acanthocytes Few (1+) 5 -15 22 -26 pg 3 -5 70 -79 fl 100 -11 - fl 1 -5 6 -20 1 -5 5 -10 1 -10 Moderate (2+) 16 -40 18 -21 pg 6 -20 60 -69 fl 111 -125 fl 6 -15 21 -50 11 -50 6 -20 11 -25 11 -30 Marked (3+) > 40 < 18 pg > 20 < 60 fl > 125 >15 >50 >20 >25 >30 Report if present Burr cells Bite cells Stomatocytes Teardrop cells* Agglutination Dimorphic red cells Dual population Howell-Jolly bodies Oval macrocytes Pappenheimer bodies Parasites Sickle cell >30% >4%
Follow this system regularly then you won’t miss anything
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