Indication of peripheral blood smear

exmination:1. For carried out differential WBC count.

2. For differential diagnosis of anemia.

3. For detection of parasites.

4. For diagnosis of leucemoid reaction.

5. For diagnosis and differential diagnosis of leukemia.

6. For detection of platelet abnormalities.

7. For diagnosis of conditions like infectious mononucleosis.

1) RBC series

2) WBC series

3) Platelets

4) Parasites

5) Other abnormal cells

final diagnosis with advice

1. Abnormalities of Haemoglobin content:-

HypochromiaHyperchromiaAnisochromiaPolychromatophilia

2. Abnormalities of size of red cells:-

MicrocytosisMacrocytosisAnisocytosis

3. Abnormalities of shape of red cells ( Poikilocytosis ):-

different abnormal shapes of RBC

I. Elliptocytosis

II. Spherocytosis

III. Target cells

IV. Schistocytosis

V. Acanthocytois

VI. Crenated cells

VII. Sickled cells

VIII. Leptocytes

4. Abnormalities of structure of red cells:-

•Basophilic stippling ( Punctate basophilia )

•Howell- jolly bodies

•Cabot rings

•Pappenheimer bodies

•Malarial stippling

•Rouleaux formation

•Agglutination

•Nucleated red cells

•No nucleus, enzyme packets•Biconcave discs – Haem + Gl•Center 1/3 pallor•Pink cytoplasm (Hb filled)•Cell size 7- 8 µ - capill. 2 µ•EM pathway, HMP•Negative charge – no phago•Na less, K more inside•100-120 days life span

Hypochromic Microcytic

The RBC‘s here are smaller than normal and have an increasedzone of central pallor. This is indicative of a hypochromic (less hemoglobin in each RBC) microcytic (smaller size of each RBC) anemia. There is also increased anisocytosis.

Microcytic

the average size of erythrocytes is smaller than normal

Macrocytic

Note the hypersegmented neurotrophil and also that the

RBC are almost as large as the lymphocyte. Finally, note

that there are fewer RBCs.

Here. Elliptocytosis,

Megaloblastic

anaemia

ELLIPTOCYTE

HS, AIHA, Thermal

injury,Burns,

Chemical poisoning,

Hypophosphataemia

SPHEROCYTE

Uraemia,Pyruvatekin

ase

defi.,Phosphoglycera

te kinase defi.

ECHINOCYTES

Disturbence in red

cell cation

composition

Hereditary

Stomatocytosis, Liver

disease, Alcoholism

STOMATOCYTE

Thalassemia Major,

Microangiopathic

Hemolytic anaemia,

Cardiac Hemolytic

anaemia

Sickle cell anemia

Thalassemia

disorder, Sickle cell

anaemia, Hb E & Hb

C disease,Liver

disease, after

splenectomy

Terminology Description Condition

Target cells Central hemoglobin; target-shaped Liver disease; thalassemia: Abnormal

Hgb; iron deficiency

Echinocyte Short spicules, equally-spaced Uremia, hypokalemia, artifact

Acanthocyte Spiculated, irregular Liver disease (alcohol), Post-splenectomy

Spherocyte Spherical, no central pallor HS, Immune hemolytic anemia

Schistocyte Fragmented RBC, helmet cells MAHA, burns

Ovalocyte Oval/elliptical shaped Hereditary elliptocytosis, Megaloblastic anemia

Sickle cell bipolar spiculated shape Hgb S-containing “banana” shaped hemoglobinopathy

Teardrop cell single elongated extremity Myelophthistic changes

Bite cells Irregular gap in membrane G6PD deficiency

Rouleaux formation Stacking of

RBCs due to

increased plasma proteins coating RBCs

Agglutination Antibody-mediated

clumping,

temperature mediated

Auto immune

hemolytic anaemia

NORMOCYTIC NORMOCHROMIC RBC

MICROCYTIC HYPOCHROMIC RBC

G6PD Deficiency

Microcytic -Thalassaemia trait

Normocytic - Lead poisoning

Normo or micro -Sideroblastic anemia

Macrocytic -Megaloblastic anemia

Post splenectomy

Splenic atrophy

Pernicious anaemia

Coeliac disease

RING OF P.VIVAX

TROPHOZOITE OF P.VIVAX

MULTIPLE RINGS OF P.FALCI

GAMATOCYTE OF P.FALCI

Cells with 5 or more

lobes are considered

hypersegmented, e.g.

megaloblastic

changes

Uraemia

After cytotoxic drug

treatment esp

methotrexate

BLAST CELL

Thank You Thank You

MYELOCYTE

BASOPHIL

MYELOBLAST

Platelets are small, 1-3 µm in diameter,

purple structures with tiny irregular

projection on surface.

Thrombocytopenia in malaria and dengue.

Causes of false thrombocytopenia on automated heamatology analyzer:

a)

Clumps of platelets Platelet satellitism.