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Blood film preparation and reporting
1. Peripheral blood smear examination
(Slide preparation and reporting)
Caesar Abu Arra
MSc Life sciences
BSc Medical lab. Sciences
Medicare Labs
2. Aim of blood smear
ī§ Evaluation of anemia
ī§ Infections
âĸ bacteria, malaria, microfilaria..etc.
ī§ Abnormal cells
âĸ blasts, inclusions..etc.
ī§ Cells morphology and count
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3. Making blood films
ī§ Three basic steps to make blood film:
ī Preparation of blood smear.
ī Fixation of blood smear.
ī Staining of blood smear.
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4. Preparation of blood smear
ī§ Different types of blood smears:
ī The wedge smearī slide to slide method.
ī The spun smear.
ī Two additional types of blood smears (used for specific
purposes):
o Buffy coat smear for WBCs < 1.0Ã109/L.
o Thick blood smears for blood parasites .
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5. Wedge blood smear
ī§ Smears should be made within 1 hour of blood
collection from EDTA specimens stored at
room temperature to avoid distortion of cell
morphology.
ī§ Small drop (10 Âĩl)
ī§ Hold the spreader slide at a 30°- 45° angle,
and draw it back against the drop of blood.
ī§ Air dry at room temperature.
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7. Procedure notes
1. The smear should be made without delay.
Any delay results in an abnormal distribution
of the white blood cells, with many of the
large white cells accumulating at the thin
edge of the smear.
2. HCTâ â The angle of the spreader slide
HCTâ â The angle of the spreader slide
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9. Spin method
ī§ Automated method
ī§ Placeadrop of blood in thecenter of aglassslide.
ī§ Spin atahighspeed in aspecialcentrifugecytospin.
ī§ Blood spreads uniformly.
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10. Characteristics of a Good Smear
ī§ Thick at one end, thinning out to a smooth
rounded feather edge.
ī§ Should occupy 2/3 of the total slide area.
ī§ Should not touch any edge of the slide.
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12. Common causes of a poor blood smear
ī§ Drop of blood too large or too small.
ī§ Spreader slide pushed across the slide in a
jerky manner.
ī§ Failure to keep the spreader slide at a 30°
angle with the slide.
ī§ Failure to push the spreader slide completely
across the slide.
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13. Common causes of a poor blood smear
ī§ Holes in film: Slide contaminated with fat or
grease
ī§ Cellular degenerative changes:
īdelay in fixing
ī Inadequate fixing time
īMethanol contaminated with water.
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14. Biologic causes of a poor smear
ī§ Cold agglutinin - RBCs will clump together.
īWarm the blood at 37° C for 5 minutes.
ī§ Lipemia - holes will appear in the smear.
īNothing you can do to correct this.
ī§ Rouleaux - RBCâs will form into stacks as coins.
īNothing you can do to correct this.
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15. Staining of blood smear
ī§ Romanowsky stain:
Any Combination of:
īEosin Y (Acidic or anionic dye):
o Binds to cationic sites (cytoplasm & Hb)
īMethylene blue (Basic, cationic or Azure B dye):
o Binds to anionic sites (nucleus and RNA)
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16. Staining of blood smear
ī§ Buffer:
ī Used to maintain an adequate pH.
ī 0.05M Na2PO4 (pH 6.4) or dH2O (pH 6.4-6.8)
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17. pH of the phosphate buffer
ī§ If the pH is too acidic:
īRBC :Pinker
īWBC nuclei : very pale staining (very pale purple)
ī§ If the pH is too basic:
īRBC :Grayish blue
īWBC nuclei :very deeply purple
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19. Staining Troubleshooting
ī§ Too Acid Stain:
īInsufficient staining time
īProlonged buffering or washing
īOld stain
ī§ Correction:
ī Lengthen staining time
ī Check stain and buffer pH
ī Shorten buffering or wash time
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20. Staining Troubleshooting
ī§ Too Alkaline Stain:
īThick blood smear
īProlonged staining
īInsufficient washing
īAlkaline pH of stain components
ī§ Correction :
ī Check pH
ī Shorten stain time
ī Prolong buffering time
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22. ī§ Macroscopic view:
ī Quality of the smear
ī§ The microscopic view:
ī Progressing from low power to high power:
Blood film examination - preliminary
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24. ī§ Low-Power (10x) Scan
ī Determine the overall staining quality of the blood
smear.
ī Determine if there is a good distribution of the cells.
o Discussed later
ī Find an optimal area for the detailed examination and
enumeration of cells
Blood film examination - preliminary
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25. ī§ High-Power (40x) Scan
ī Determine the WBC estimate.
o WBCs are counted in 10 fields and averagedī X 2000
o The estimate could be reported according to the table below:
Blood film examination - preliminary
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26. âĸ High-Power (40x) Scan
ī Grading scale for WBC count (X103 cell/Âĩl)
Blood film examination - preliminary
Low WBC High WBC
Mild 3-4.5 Mild 10-15
Moderate 2-3 Moderate 15-30
Severe <2 Marked 30-100
Extreme >100
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27. ī§ Oil Immersion (100x) Examination
ī Perform a 100 WBC differential count.
ī Correct WBC count that has greater than 10 NRBCs per
100 WBCs.
o Report as: WBC count was corrected due to presence of
NRBCs.
Blood film examination - preliminary
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28. ī§ Oil Immersion (100x) Examination
ī to correct a WBC count (/Âĩl):
Uncorrected WBC (/ ) X l
Blood film examination - preliminary
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29. ī§ Oil Immersion (100x) Examination
ī Evaluate the RBCs for:
o Anisocytosis
o Poikilocytosis
o Inclusions
o Hypochromasia
o Polychromasia.
Blood film examination - preliminary
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30. ī§ Oil Immersion (100x) Examination
ī Perform a platelet estimate and evaluate platelet
morphology:
o Platelets are counted in 10 fields and averaged:
âĸ X 15 ī Automated smear.
âĸ X 20 ī Wedge smear is used.
Blood film examination - preliminary
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31. ī§ Oil Immersion (100x) Examination
ī Grading scale for platelets count (X103 cell/Âĩl)
Blood film examination - preliminary
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Low Platelets High Platelets
Mild 100-150 Mild 500-700
Moderate 50-100 Moderate 700-900
Severe <50 Severe 900-1000
Extreme >1000
32. ī§ Oil Immersion (100x) Examination
ī The absolute WBC count (/Âĩl) may be determined:
Relative count (%) X Total WBC count (/Âĩl)
Blood film examination - preliminary
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33. ī§ Relative vs. Absolute value:
ī Relative value:
o Measures the percentage of corresponding WBC type in
peripheral blood.
Blood film examination - preliminary
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34. ī§ Relative vs. Absolute value:
ī Absolute value:
o Measures the total count of corresponding WBC type /Âĩl
in peripheral blood.
o Gives more meaningful information than the percentage.
o It is the preferred reporting method for the WBC
differential.
âĸ Reported as absolute cytosis or absolute cytopenia.
Blood film examination - preliminary
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35. ī§ Relative vs. Absolute value:
Example: leukopenic patient and increased susceptibility
to infection and sepsis:
ī WBC=5000 Relative Neutrophils=50%
o Absolute= 2500 cell/Âĩl Normal
ī WBC=2000 Relative Neutrophils=85%
o Absolute= 1700 cell/Âĩl Low
Blood film examination - preliminary
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37. ī§ Examination of blood films should include:
īļ RBC
īSize, Shape, color
īHemoglobin distribution
īArrangement and distribution
īInclusions
īnucleated RBCs
Examination of blood films
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38. ī§ Examination of blood films should include:
īļ WBC
ī Total counts
ī Differential counts
ī Abnormal and immature WBC
Examination of blood films
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39. ī§ Examination of blood films should include:
īļPlatelets
ī Countsī should be verified by estimation
ī Size
ī Clumping
Examination of blood films
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40. ī§ Examination of blood films should include:
īļParasites
Examination of blood films
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41. ī§ Pancytopenia
Deficiency in all the three cell lines RBC, WBC, and platelets.
ī Aplastic anemia
ī When report, recommend bone marrow assessment.
ī§ Bicytopenia
Deficiency in two of the three cell lines
ī Viruses and drugs
Terms
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45. ī 1 to 4 Îŧm in diameter and vary in shape.
ī Reddish-purple granules
ī Life span 9-12 days
ī One megakaryocyte can release several thousand platelets
(4000).
ī Report as platelets are adequate with normal-sized ones
OR platelets are normal
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Platelets
46. ī§ Large and Giant platelets
īLarge platelets (4-7 Âĩm)
oITP
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Platelets
47. ī§ Large and Giant platelets
īGiant platelet (7-20 Âĩm)
oPlatelets seems to be size of RBC.
oBernard Soulier syndrome
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Platelets
48. ī§ Large and Giant platelets
īNOTE:
o When estimate, Large platelets and platelet aggregates
NOT counted.
īReport as Occasional, Few, Many
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Platelets
49. ī§ Platelet anisocytosis:
īSmall large giant platelets will be seen
ī§ Report as: Platelets anisocytosis ranging in size from
tiny to large giant platelets were seen.
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Platelets
50. ī§ Thrombocytosis
ī Post infection and Inflammation
ī Report as:
o Thrombocytosis (with grading).
o Platelets were estimated and approved to be about ( /Âĩl)
ī In case of microcytosis (RBC and PLT diameters are
similar) report as :
o Thrombocytosis due severe microcytosis.
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Platelets
51. ī§ Thrombocytopenia:
īCould be due to:
o Decreased productionī Aplastic anemia
o Increased destructionī ITP
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Platelets
52. ī§ Thrombocytopenia:
ī In case of no aggregates report as:
o Thrombocytopenia (with grading).
o No platelet clumps are noted OR Negative for
microaggregates.
o Platelets were estimated and approved to be about ( /Âĩl)
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Platelets
55. ī§ Pseudothrombocytopenia:
īRepeat on new samples (EDTA and sodium citrated)
īScan for platelet clumping in thin and thick portion of
smear
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Platelets
56. ī§ Pseudothrombocytopenia:
īReporting criteria:
īTwo samples were drawn to rule out EDTA- induced
pseudothrombocytopenia:
o EDTA smear revealed platelet clumps / Platelet
satellitism
o Na+ citrated smear revealed normal platelets count and
distribution.
īConclusion: Platelets are adequate
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Platelets
57. Morphology of Normal RBC
ī Biconcave disc
ī Diameter 7 ~ 8 Îŧm
ī Central pallor occupy 3rd of total size
ī Approx same as nucleus of mature lymphocyte
ī Stained with eosin component of Romanowsky dyes
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RBC
59. RBC Abnormality
ī§ Examination of blood films for RBCâs should
include:
ī Anisocytosis
ī Poikilocytosis
ī Hemoglobin distribution
ī Arrangement and Distribution
ī Inclusions
ī NRBCs
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61. Arrangement and Distribution
ī§ Normal arrangement and distribution:
ī The thin portion of the smear where RBCâs are slightly
separated from one another or at most, barely touching,
with no overlap.
ī The thin area should represent at least 3rd of the entire
film.
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62. Arrangement and Distribution
ī§ Normal arrangement and distribution:
ī The reviewer should avoid the thicker portion of the
slide where cells are overlapping and the edges of smear
where cells may be distorted in size, shape, and color.
o An exception is to be made when scanning for platelet
clumping
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63. Arrangement and Distribution
ī§ Rouleaux
ī RBCâs appear as stacks of coins (linear)
ī Due to â Globulins or fibrinogens
ī seen in:
o Multiple myeloma
o Macroglobulinemia
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64. Arrangement and Distribution
ī§ Agglutination
ī More irregular and round clumping than linear rouleaux
ī Seen in:
o Cold agglutinin
o Anti RBC antibodies
o Autoimmune HA
o Macroglobulinemia
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65. Inclusions
ī§ Basophilic stippling (Punctate basophilia)
ī Aggregates of Ribrosomes.
ī Multiple blue black inclusions (coarse or punctate )
ī Seen in:
o Lead and arsenic poisoning
o Thalassemias
o Alcoholism
o Megaloblastic anemias
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66. Inclusions
ī§ Howell Jolly bodies
ī Large round inclusions which are remnant of nuclear
chromatin
ī Appear singly or doubly in an eccentric position on the
cell periphery
ī Deep purple
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67. Inclusions
ī§ Howell Jolly bodies
ī Seen in:
o Postsplenectomy
o Megalobalstic anaemia
o Haemolytic anaemia
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69. Inclusions
ī§ Pappenheimer Bodies
ī Unlike basophilic stippling:
o Basophilic stippling appears homogeneously over the cell
whereas Pappenheimers tend to appear as single or clusters
in the cells periphery.
ī Unlike HowellâJolly bodies:
o HowellâJolly bodies appear to be
larger
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71. Inclusions
ī§ Heinz bodies
ī Result of denatured or precipitated hemoglobin
ī Purple, blue, large, single or multiple inclusions
attached to the inner surface of the red blood cell.
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72. Inclusions
ī§ Heinz bodies
ī Stained by supravital stains
ī Not Stained by Romanowsky stain.
ī Seen in:
o Postsplenectomy
o oxidant stress of drugs and
chemicals
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73. Inclusions
ī§ Cabot rings
ī Represent a part of the mitotic spindle, remnants of
microtubules, or a fragment of the nuclear membrane.
ī Have no internal structure
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74. Inclusions
ī§ Cabot rings
ī Red or reddish purple
ī Could be appear in a figure-of-eight conformation
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77. Poikilocytosis
ī§ Spherocytes
ī Loss of biconcavity
o â Surface-to-volume ratio
o â Osmotic fragility
ī Smaller diameter
ī Dense-staining
o No central pallor area
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79. Poikilocytosis
ī§ Target cell
ī Codocytes
ī â membrane cholesterol and phospholipid and â cellular
hemoglobin.
ī â surface-to-volume ratio
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80. Poikilocytosis
ī§ Target cell
ī Seen in:
o Obstructive liver disease
o Iron deficiency anemia
o Thalassemia
o Post-transfusion
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83. Poikilocytosis
ī§ Elliptocyte and ovalocyte
ī Elliptocytes
o Pencil, rod, or cigar shaped
o Hb appears to be concentrated on both ends of the cell
o Seen in IDA
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84. Poikilocytosis
ī§ Elliptocyte and ovalocyte
ī Ovalocyte
o More egg-shaped
o Have a greater tendency to vary in their Hb content
o Seen in megaloblastic anemia
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87. Poikilocytosis
ī§ Stomatocyte
ī RBC with narrow slit-like area of central pallor
ī Normal size, but are not biconcave
ī Seen in:
o Acute alcoholism
o Hemolytic anemia
o Malignancies
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90. Poikilocytosis
ī§ Echinocyte
ī Burr Cells, crenated cells
ī 10 to 30 regular spicules, evenly placed over the surface
of RBC
ī Considered pathologic and should be reported.
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93. Poikilocytosis
ī§ Fragmented cells
ī All fragmented RBC reported as schistocytes
ī Sometimes counted as platelets
o Estimate platelets and report thrombocytosis due to
presence of RBC fragments
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98. Anisocytosis
ī§ Microcytes
ī MCV <80 fl
ī Diameter <7 Îŧm
ī Results from a defect in hemoglobin formation
ī Seen in:
o IDA
o Thalassemia
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99. Anisocytosis
ī§ Macrocytes
ī MCV >100 fl
ī Diameter >9 Îŧm
ī Result from impaired DNA synthesis.
ī Seen in:
ī Megaloblastic anemia (â B12 and folic acid).
ī Aplastic anaemia
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100. Anisocytosis
ī Anisocytosis is a feature of most anemias.
o Report as anisocytosis (with Qual. or Quan. Grading):
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RDW: 16-18 ī Slight
RDW: 18-22 ī Moderate
RDW: >22ī Marked or severe
101. Anisocytosis
ī§ Mixture of large and small with normal MCV and high
RDW usually due:
īRecent blood transfusion
īAnemia or recovery stages of anemia.
o Report as Anisocytosis with dimorphic RBC population
(with grading):
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RDW: 16-18 ī Slight
RDW: 18-22 ī Moderate
RDW: >22ī Marked or severe
102. Hemoglobin Distribution
ī§ MCHC used in conjunction with MCV used
do describe anemias
īNormochromia
īHypochromia
īHyperchromia
īPolychromasia
īAnisochromia
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104. Hemoglobin Distribution
ī§ Hypochromia : MCHC < 32%
ī Unusually palely RBC (âHb content)
ī The central pallor > 3Âĩm (>1/3 rd of total size)
ī Seen in:
o IDA
o Thalassemia
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106. Hemoglobin Distribution
ī§ Hyperchromia : MCHC > 36%
ī Decreased or absent central pallor
ī Seen in:
o Sperocytosis (âsurface-to-volume ratio)
o hemolytic anemias (hemolysis caused by burns)
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107. Hemoglobin Distribution
ī§ Hyperchromia : MCHC > 36%
ī Even though true hyperchromia does exist it is not
reported as such:
o It is reported in terms of the cell abnormalities resulting
from the increased volume of hemoglobin and the
decreased surface area (e.g spherocytes).
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108. Hemoglobin Distribution
ī§ Polychromasia
ī Premature RBC in circulation called Polychromatophilic
cellsī actually reticulocytes.
ī Gray-blue in color and usually larger than normal RBC
o Result of the residual RNA involved in Hb synthesis.
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110. Hemoglobin Distribution
ī§ Polychromasia
ī Gradingī excellent indicator of therapeutic effectiveness
when patient is given iron or vitamin therapy as treatment
of anemia
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111. Hemoglobin Distribution
ī§ Anisochromia
ī Hypochromic cells and normochromic cells in the
same film
ī Seen in:
o Development or recovering from anemias
o Post-transfusion
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113. White blood cells
ī§ WBC categories:
ī Granulocytes (PMN):
o Neutrophils, Eosinophils and basophiles
o Granules in their cell cytoplasm.
o Multilobed nucleus
ī Agranulocytes (MNC):
o Lymphocytes and monocytes.
o Do not have granules (contain non specific azurophilic
granules)
o Nonlobular nuclei.
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115. Neutrophil
ī§ Terms
ī Shift to the left
o Release of younger granulocytes (specifically bands and
metamyelocytes from the bone marrow).
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116. Neutrophil
ī§ Terms
ī Shift to the right
o An abnormal cell maturation situation that occurs when
hypersegmented cells are seen.
âĸ It is indicative of vitamin B12 and/or folate deficiency.
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118. Neutrophil
ī Report as:
o Mature/normal appearing neutrophils.
o In case of leukocytosisī neutrophilic leukocytosis
o Absolute / relative neutrophilia or neutropenia
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119. Neutrophil
ī Neutrophilia
o Acute bacterial infection.
o Many inflammatory processes.
ī Neutropenia
o Typhoid fever
o Brucellosis
o Viral diseases.
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120. Abnormal neutrophil
ī§ Abnormal neutrophil morphology:
īBand or stab forms
īHypersegmentation (âĨ 6 lobes)
īVacuolization
īToxic granulation
īDohle bodies
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121. Band or Stab
ī Cytoplasm
o Pink
ī Nucleus
o U shaped nucleus of uniform thickness.
o Purplish red
o Dense chromatin
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122. Band or Stab
ī Normally form 5-10% of WBCâs
ī Increased bands:
o Acute infection (usually bacterial)
o Non infectious inflammatory disease
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123. Band or Stab
ī Include it when calculate absolute neutrophil
ī Report as:
o Many/Few neutrophilc bands OR with shift to the
left
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125. Hypersegmentation
ī Report as:
o Few/many hypersegmented neutrophils OR with shift to
the right.
o Further hematological examinations are recommended
(B12 & folic acid).
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126. Vacuolization
ī Vacuoles in neutrophil contain ingested microorganisms.
ī Seen in:
o Severe infection (leukemoid reaction)
o Non infectious inflammation
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127. Toxic granulation
ī â staining density and number of granules
ī Seen in:
o Bacterial infection and leukemoid reaction
o Other inflammation
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128. DÃļhle bodies
ī Pale blue inclusions at the periphery of the cytoplasm
ī Strands of RER that have aggregated
o Bacterial infection and leukemoid reaction
o Inflammation
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130. Eosinophil
ī Cytoplasm
o Full of orange-red granules
ī Nucleus
o Blue purple
o Coarsely granular chromatin
o 2 Lobes (like a pair of glass)
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133. Basophil
ī Cytoplasm
o Pale blue with coarse violet-blue granules
ī Nucleus
o Blue purple
o Coarsely granular chromatin
o 2 Lobes
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136. Monocyte
ī Cytoplasm
o Pale gray-blue
o Vacuoles and granules may be observed
ī Nucleus
o Blue-purple
o large irregularly, folded, kidney shaped, âĻ.etc
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141. Lymphocyte
ī Report as:
o Mature-appearing lymphocytes with homogenous chromatin
pattern (Resting lymphocytes).
o In case of leukocytosisī Lymphocytic leukocytosis
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144. Abnormal lymphocyte
ī§ Abnormal lymphocyte morphology:
īReactive lymphocytes
īSmudge cells (Basket cell)
īTurk cell (Transformed lymphocyte or immunoblast)
īAtypical Lymphocytes (Malignant-appearing cell)
All should be reported
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145. Reactive lymphocyte
ī Normally < 10% of the total lymphocytes
ī Nucleus:
o Slightly large with more open chromatin
ī Cytoplasm:
o Abundant and irregular (âN:C)
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146. Reactive lymphocyte
ī Seen in:
o Infectious mononucleosis
o Viral infections
ī The term atypical should not be used interchangeably with
reactive lymphocyte.
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147. Smudge cell
ī Normally < 1%
ī Remnants of cells that lack:
o Identifiable cytoplasmic membrane and Nuclear structure.
ī Associated with abnormally fragile lymphocytes (mostly
CLL)
ī Should be reported.
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148. Turk cell
ī Reactive lymphocyte with large nucleolus, abundant and
deeply basophilic cytoplasm
ī Seen in bacterial and viral infection
ī Round nucleus
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150. Leukemia
ī§ Two major types according to cell maturity:
ī Acute
o The malignant cells are immature (stem cells, blasts, or other
immature precursors.
ī Chronic
o The cells are predominantly mature.
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151. Leukemia
ī§ Two major types according to cell lineage:
īMyeloid (Myelogenous)
o Granulocytic leukemia
o Monocytic leukemia
o Megakaryocytic leukemia
o Erythrocytic leukemia
īLymphoid (Lymphocytic)
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152. Leukemia
ī§ So, four major types of leukemias:
ī Acute myeloid leukemia (AML)
ī Chronic myeloid leukemia (CML)
ī Acute lymphoblastic leukemia (ALL)
ī Chronic lymphocytic leukemia (CLL)
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154. WBC Reporting
ī§ WBC Reporting should includes:
īLeukocytosis/Leukocytopenia.
īMaturation stage
īAbsolute value of major cell.
īChromatin (fine, coarse, clumped)
īNucleolus ??
īAmount of cytoplasm ??.
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155. WBC Reporting
ī§ WBC Reporting should includes:
īFor Leukemia, recommend flow cytometry for
immunological markers
īFor CMLī Recommend Philadelphia chromosome
(BCRâABL fusion geneī positive >95%)
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164. CML
ī§ CML is characterized by three phases
īChronic phase
īAccelerated phase
īBlast phase
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165. CML
ī§ Chronic phase
ī Neutrophilic leukocytosis
o From segmented neutrophils to occasional blasts (â¤10%)
īļBut mainly mature
ī Basophilia/eosinophilia
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166. CML
ī§ Chronic phase
ī Thrombocytosis (~50% of cases).
ī Normocytic anemia
ī â uric acid , LDH, Vitamin B12
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167. CML
ī§ Accelerated phase
ī Worsening of anemia
ī Basophils (>20%).
ī Shift to the more immature myeloid forms (blasts 10-19%).
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168. CML
ī§ Accelerated phase
ī Persistent thrombocytopenia ( 100 X 109/L)
ī Persistent thrombocytosis ( 1000 X 109/L)
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171. Leukemoid reaction
ī§ Moderate or marked leukocytosis
īUsually
o >30000 cell/Âĩl
īAbsolute neutrophilia
īShift to the left
o Mostly neutrophilic metamyelocytes and band forms.
o Immaturity is similarly observed in the early stages of
CML
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172. Leukemoid reaction
ī§ Not a result of a leukemic disease
īInfectious disease
o Bacterial (most common)
o Toxoplasma and viral (less common)
īOther inflammatory process
o Uremia, acute gout and burns
īDrug and chemical intoxication
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173. Leukemoid reaction
ī§ Reactive changes of neutrophils
ī Usually appear as follow arrangement
1- Toxic granulation
o Nonspecific reactive changes
2- DÃļhle bodies
o Nonspecific reactive changes
3- Cytoplasmic vacuolization
o Strongly indicates a serious bacterial infection
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174. Leukemoid reaction
ī§ Reactive changes of neutrophils
ī Usually appear as follow arrangement
1- Toxic granulation
o Nonspecific reactive changes
2- DÃļhle bodies
o Nonspecific reactive changes
3- Cytoplasmic vacuolization
o Strongly indicates a serious bacterial infection
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176. ī§ Report as:
īWBC immaturity.
īNeutrophils reactive changes
īFeatures in keeping with marked response to infectious
or inflammatory processes (Leukemoid reaction).
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Leukemoid reaction
177. ī§ Slight leukocytosis with neutrophilia
īWith or without the shift to the left.
īToxic granulation
ī§ Report as:
īFeatures in keeping with mild response to infection
or inflammatory process.
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Mild infection
178. ī Mild to severe normocytic normochromic anemia
ī â platelet counts
ī WBC count is variable (â to âââ)
ī Auer rods in blasts cytoplasm (for AML)
ī The blood smear usually reveals blasts or other immature
cells
ī Circulating NRBC are occasionally seen
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AML & ALL
194. ī Normochromic normocytic anemia
ī â Indirect serum bilirubin level
ī Thrombocytopenia is not common.
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CLL
195. ī Lymphocytic leukocytosis From mature appearing
lymphocytes to prolymphocytes (10%)
o Small lymphocytes or slightly larger than a normal
lymphocyte and have a hypercondensed nuclear
chromatin pattern
ī Smudge cells are common
Abu Jad Caesar
CLL
197. ī WBC Reporting
o Leukocytosis/Leukocytopenia.
o Maturation stage
o Smudge cell
o Chromatin (fine, coarse, clumped)
o Nucleolus ?? (for prolymphocyte)
o Amount of cytoplasm ??.
o For definitive diagnosis, recommend flow cytometry for
immunological markers.
Abu Jad Caesar
WBC Reporting for CLL
198. ī WBC Reporting
o Mostly reported as: Mature-appearing lymphocyte with
hypercondensed nuclear chromatin pattern and few/many
prolymphocytes
Abu Jad Caesar
WBC Reporting for CLL