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A peripheral blood smear
How to look at A peripheral blood smear
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Low Power 1- Scan the slide under low power (10x) 2- Find a good area 3- Evaluate red cell distribution 4- Evaluate the white count 1 WBC = mm3
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Too thick area Red cells appear as; microcyte hypochrome rouleaux
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Too thick area
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Too thin Red cells appear as macrocyte spherocyte poikilocyte
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Too thin area
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Good area
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What are you looking for at a peripheral smear (Oil immersion)
Red cell morphology Platelet number and morphology WBC differential and morphology Blood parasite
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RBC MORPHOLOGY
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Size Shape Color Inclusion Distribution
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Evaluate red cells for size
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Normocytes
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Microcytes
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Macrocytes
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Macro-ovalocytes
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Anisocytosis
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Hb content & distribution
color Hb content & distribution
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Normochrome
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Hypochrome
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spherocyte
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Microspherocyte
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Dimorphic population
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Target cells
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Stomatocytes
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shape
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Normocyte
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Tear-drop cells
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Acanthocytes
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Echinocytes
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Ovalocyte - Elliptocyte
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Sickle cells
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Keratocyte (Horn cell)
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Pincher cells
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Schistocytes
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Distribution
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Erythrocyte antibody rosetting (EA-rosetting)
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Rouleaux formation
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Inclusions
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HbH(Golf ball)
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HbC crystal
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Basophilic stippling
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Howell Jolly bodies
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Pappenheimer bodies
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Cabot ring
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babesia
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Nucleated red blood cell (NRBC)
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Beware of artifacts! 1) Water spots 2) Precipitated stain 3) Aged RBC
4) Refractiles
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Refractiles: Humidity; under-fixation late fixation presence of water in alcohol used excess buffer to stain thick smear
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Refractiles: Increased central pallor but a normal thick rim of Hb.
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Artifact(water spots)
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Precipitated stain
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Reference guide for grading red blood cell morphology
RBC type Normal Few (1+) Moderate (2+) Marked (3+) Hypochromia < 5 27-34 pg 5-15 22-26 pg 16-40 18-21 pg > 40 < 18 pg Polychromasia < 3 3-5 6-20 > 20 Microcytes fl 70-79 fl 60-69 fl < 60 fl Macrocytes fl fl > 125 Schistocytes 1-5 6-15 >15 Elliptocytes <6 21-50 >50 Rouleaux 11-50 Spherocytes >20 Target cells <5 5-10 11-25 >25 Acanthocytes 1-10 11-30 >30 Report if present Burr cells >30% Bite cells >4% Stomatocytes Teardrop cells* Agglutination Dimorphic red cells Dual population Howell-Jolly bodies Oval macrocytes Pappenheimer bodies Parasites Sickle cell *Teardrop cells accompanied by NRBCs can be reported even <4%.
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Follow this system regularly then you won’t miss anything
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