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A peripheral blood smear

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Presentation on theme: "A peripheral blood smear"— Presentation transcript:

1 A peripheral blood smear
How to look at A peripheral blood smear

2 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

3

4 Too thick area Red cells appear as; microcyte hypochrome rouleaux

5 Too thick area

6 Too thin Red cells appear as macrocyte spherocyte poikilocyte

7 Too thin area

8 Good area

9 What are you looking for at a peripheral smear (Oil immersion)
Red cell morphology Platelet number and morphology WBC differential and morphology Blood parasite

10 RBC MORPHOLOGY

11 Size Shape Color Inclusion Distribution

12 Evaluate red cells for size

13 Normocytes

14 Microcytes

15 Macrocytes

16 Macro-ovalocytes

17 Anisocytosis

18 Hb content & distribution
color Hb content & distribution

19 Normochrome

20 Hypochrome

21 spherocyte

22 Microspherocyte

23 Dimorphic population

24

25 Target cells

26 Stomatocytes

27 shape

28 Normocyte

29 Tear-drop cells

30 Acanthocytes

31 Echinocytes

32 Ovalocyte - Elliptocyte

33 Sickle cells

34 Keratocyte (Horn cell)

35 Pincher cells

36 Schistocytes

37 Distribution

38 Erythrocyte antibody rosetting (EA-rosetting)

39 Rouleaux formation

40

41 Inclusions

42 HbH(Golf ball)

43 HbC crystal

44 Basophilic stippling

45 Howell Jolly bodies

46 Pappenheimer bodies

47 Cabot ring

48 babesia

49

50 Nucleated red blood cell (NRBC)

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

52 Refractiles:  Humidity; under-fixation late fixation presence of water in alcohol used excess buffer to stain thick smear 

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

54 Artifact(water spots)

55 Precipitated stain

56 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%.

57 Follow this system regularly then you won’t miss anything


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