How to look at A peripheral blood smear

  • Slides: 57
Download presentation
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 -

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 Red cells appear as; • microcyte • hypochrome • rouleaux

Too thick area

Too thick area

Too thin Red cells appear as • macrocyte • spherocyte • poikilocyte

Too thin Red cells appear as • macrocyte • spherocyte • poikilocyte

Too thin area

Too thin area

Good area

Good area

What are you looking for at a peripheral smear (Oil immersion) • • Red

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

RBC MORPHOLOGY

r lo Co n io ut rib st Di n o i s u

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

Evaluate red cells for size

Normocytes

Normocytes

Microcytes

Microcytes

Macrocytes

Macrocytes

Macro-ovalocytes

Macro-ovalocytes

Anisocytosis

Anisocytosis

Hb content & distribution

Hb content & distribution

Normochrome

Normochrome

Hypochrome

Hypochrome

spherocyte

spherocyte

Microspherocyte

Microspherocyte

Dimorphic population

Dimorphic population

Target cells

Target cells

Stomatocytes

Stomatocytes

shape

shape

Normocyte

Normocyte

Tear-drop cells

Tear-drop cells

Acanthocytes

Acanthocytes

Echinocytes

Echinocytes

Ovalocyte - Elliptocyte

Ovalocyte - Elliptocyte

Sickle cells

Sickle cells

Keratocyte (Horn cell)

Keratocyte (Horn cell)

Pincher cells

Pincher cells

Schistocytes

Schistocytes

Distribution

Distribution

Erythrocyte antibody rosetting (EA-rosetting)

Erythrocyte antibody rosetting (EA-rosetting)

Rouleaux formation

Rouleaux formation

Inclusions

Inclusions

Hb. H(Golf ball)

Hb. H(Golf ball)

Hb. C crystal

Hb. C crystal

Basophilic stippling

Basophilic stippling

Howell Jolly bodies

Howell Jolly bodies

Pappenheimer bodies

Pappenheimer bodies

Cabot ring

Cabot ring

babesia

babesia

Nucleated red blood cell (NRBC)

Nucleated red blood cell (NRBC)

Beware of artifacts! 1) Water spots 2) Precipitated stain 3) Aged RBC 4) Refractiles

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

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.

Refractiles: Increased central pallor but a normal thick rim of Hb.

Artifact(water spots)

Artifact(water spots)

Precipitated stain

Precipitated stain

Reference guide for grading red blood cell morphology Normal < 5 27 -34 pg

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

Follow this system regularly then you won’t miss anything