Correct interpretation of prepheral blood smear

Dr bakhshandeh.APCP.MD,

• RBC related abnormality

• WBC`S and related abnormality

• PLT

Normal Cells of the Blood

Immature White Cell Precursors: Myeloblasts and Promyelocytes

POLYMORPHONUCLEAR NEUTROPHILS

• A relative left shift in the granulocyte series means less mature forms in excess of 5% band neutrophils; the preceding, less differentiated cell forms are included and all transitional forms are taken into account. This left shift almost always indicates an increase in newcell production in this cell series.

• In most cases, it is associated with a raised total leukocyte count. However, since total leukocyte counts are subject to various interfering factors that can also alter the cell distribution, left shift without leukocytosis can occur, and has no further diagnostic value

Pyknotic Neutrophils (Apoptosis)

• in the blood, especially when there is an infection. They may also develop in normal blood in vitro after standing for 12-18 hours, even if kept at 4°C. These cells have round, dense, featureless nuclei, and their cytoplasm tends to be dark pink

• More frequent apoptotic cells can be seen in leukaemia.

EOSINOPHILS

MONOCYTES

• Monocytes are the largest of the circulating leucocytes, 15-18 micron in diameter. They have bluish-grey cytoplasm that contains variable numbers of fine reddish granules. The The nucleus is large and curved, often in the shape of a horseshoe, but it may be folded or curled

• . It never undergoes segmentation.

• The chromatin is finer and more evenly distributed in the nucleus than in neutrophil nuclei.

LYMPHOCYTES

• lymphoblasts of acute lymphoblastic leukaemia vary in size from only slightly larger than lymphocytes to cells of 15-17 11m diameter. The nuclei generally have diffuse chromatin, but there may be some chromatin condensation in the smaller blasts. The cytoplasm varies from weakly to strongly basophilic.

Acute Lymphoblastic Leukemia (ALL)

• ALL are the leukemias in which the cells do not morphologically resemble myeloblasts, promyelocytes, or monocytes, nor do they show the corresponding cytochemical pattern. Common attributes are a usually slightly smaller cell nucleus and denser chromatin structure, the grainy consistency of which can be made out onlywith optimal smear technique (i.e.,very light).