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Blood smear morphology
The document provides information about peripheral blood smear morphology and summarizes several case examples. It discusses how a peripheral blood smear can provide useful information by examining the physical properties and staining characteristics of blood cells. The summary then briefly outlines the hematological findings and peripheral blood smear morphology for 3 cases: iron deficiency anemia, thalassemia (HbH), and hereditary spherocytosis.
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Blood smear morphology
- 1. Basic Morphology Kaipol Takpradit,MD Departmentof Medicine Bhumibol Adulyadej Hospital
- 2. Introduction Peripheral Blood Smear Verysimple investigation Provide useful informations The first to check when CBC show abnormal
- 3. How to makePBS
- 4. How to makePBS
- 5. Understanding PBS Morphology ofcells result from physical property of cells Physic not Magic!!
- 6. Principle of PBS Findproper area Known relative cell size Known how cell’s composition stain Known normal
- 7. Romanowsky stain Acidic +basic = neutral dye staining (Eosin Y + methylene blue) in methanol = Wright’s stain
- 8. Wright’s stain Basophilia (methyleneblue) Azurophilia (oxidized methylene blue) Acidophilia (eosin) Neutrophilia (mixture of dye)
- 9. Wright’s stain Basic dyebind to acid Nucleic acid (DNA, RNA) Protein Acidic dye bind to base Cytoplasm Hemoglobin
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- 17. Abnormal RBC Hemoglobin leakagecells Ghost cell
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- 23. Complete blood count Hematocrit= packed red cell volume Hemoglobin = concentration of Hb Platelet count = amount of Plt. WBC count = show amount of RBC and differential by flow cytometry
- 24. Complete blood count MCV= volume of RBC (fL) MCH = Amount of hemoglobin (pg) MCHC = Hb concentration in each cells RDW = variety of RBC size
- 25. MCV Normal 85 -95 1 trait 70 + 8.7 2 trait 85 + 5.5 trait 68 + 6.9 Hb E trait 84 + 5.1 Hb EE 73 + 5.7 Hb H disease 67 + 6.7 /E thal 69 + 5.6 thal 55 - 65
- 26. Complete blood count Hctis approximately 3 times of Hb HbH has Hct higher that expected MCHC is high in hereditary spherocytosis RDW is usually wide in abnormal RBC formation
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- 28. Iron deficiency anemia Hct21% Hb 6.9 g/dL WBC 7,000/mcL PMN 75% Plt 500,000/mcL MVC 67 fL MCH 20 pg MCHC 21 g/dL RDW 20%
- 29. Iron deficiency anemia Hct21% Hb 6.9 g/dL WBC 7,000/mcL PMN 75% Plt 500,000/mcL MVC 67 fL MCH 20 pg MCHC 21 g/dL RDW 20%
- 30. Thalassemia (HbH) Hct 26%Hb 7 g/dL WBC 7,000/mcL PMN 75% Plt 350,000/mcL MVC 67 fL MCH 20 pg MCHC 21 g/dL RDW 20%
- 31. Thalassemia (HbH) Hct 26%Hb 7 g/dL WBC 7,000/mcL PMN 75% Plt 350,000/mcL MVC 67 fL MCH 20 pg MCHC 21 g/dL RDW 20%
- 32. Thalassemia trait Hct 36%Hb 12 g/dL WBC 7,000/mcL PMN 75% Plt 350,000/mcL MVC 78 fL MCH 24 pg MCHC 25 g/dL RDW 12%
- 33. Thalassemia trait Hct 36%Hb 12 g/dL WBC 7,000/mcL PMN 75% Plt 350,000/mcL MVC 78 fL MCH 24 pg MCHC 25 g/dL RDW 12%
- 34. Homozygous HbE Hct 35%Hb 12 g/dL WBC 7,000/mcL PMN 75% Plt 350,000/mcL MVC 75 fL MCH 24 pg MCHC 25 g/dL RDW 12%
- 35. Homozygous HbE Hct 35%Hb 12 g/dL WBC 7,000/mcL PMN 75% Plt 350,000/mcL MVC 75 fL MCH 24 pg MCHC 25 g/dL RDW 12%
- 36. Hereditary spherocytosis Hct 30%Hb 10 g/dL WBC 7,000/mcL PMN 75% Plt 120,000/mcL MVC 80 fL MCH 31 pg MCHC 38 g/dL RDW 15%
- 37. Hereditary spherocytosis Hct 30%Hb 10 g/dL WBC 7,000/mcL PMN 75% Plt 120,000/mcL MVC 80 fL MCH 31 pg MCHC 38 g/dL RDW 15%
- 38. AIHA Hct 20% Hb7 g/dL WBC 20,000/mcL PMN 75% Plt 200,000/mcL MVC 92 fL MCH 31 pg MCHC 38 g/dL RDW 22%
- 39. AIHA Hct 20% Hb7 g/dL WBC 20,000/mcL PMN 75% Plt 200,000/mcL MVC 92 fL MCH 31 pg MCHC 38 g/dL RDW 22%
- 40. G-6-PD deficiency Hct 22%Hb 7 g/dL WBC 20,000/mcL PMN 75% Plt 200,000/mcL MVC 92 fL MCH 31 pg MCHC 38 g/dL RDW 22%
- 41. G-6-PD deficiency Hct 22%Hb 7 g/dL WBC 20,000/mcL PMN 75% Plt 200,000/mcL MVC 92 fL MCH 31 pg MCHC 38 g/dL RDW 22%
- 42. ITP Hct 37% Hb12 g/dL WBC 8,000/mcL PMN 75% Plt 20,000/mcL MVC 85 fL MCH 31 pg MCHC 30 g/dL RDW 12%
- 43. ITP Hct 37% Hb12 g/dL WBC 8,000/mcL PMN 75% Plt 20,000/mcL MVC 85 fL MCH 31 pg MCHC 30 g/dL RDW 12%
- 44. TTP Hct 30% Hb10 g/dL WBC 8,000/mcL PMN 75% Plt 60,000/mcL MVC 91 fL MCH 31 pg MCHC 30 g/dL RDW 18%
- 45. TTP Hct 30% Hb10 g/dL WBC 8,000/mcL PMN 75% Plt 60,000/mcL MVC 91 fL MCH 31 pg MCHC 30 g/dL RDW 18%
- 46. CLL Hct 28% Hb9 g/dL WBC 50,000/mcL Lymph 80% Plt 190,000/mcL MVC 81 fL MCH 31 pg MCHC 30 g/dL RDW 13%
- 47. CLL Hct 28% Hb9 g/dL WBC 50,000/mcL Lymph 80% Plt 190,000/mcL MVC 81 fL MCH 31 pg MCHC 30 g/dL RDW 13%
- 48. CML Hct 31% Hb9 g/dL WBC 80,000/mcL PMN 30% myelo 20% meta 10% pro 10% Plt 590,000/mcL MVC 81 fL MCH 31 pg MCHC 30 g/dL RDW 13%
- 49. CML Hct 31% Hb9 g/dL WBC 80,000/mcL PMN 30% myelo 20% meta 10% pro 10% Plt 590,000/mcL MVC 81 fL MCH 31 pg MCHC 30 g/dL RDW 13%
- 50. Primary myelofibrosis Hct 28%Hb 9 g/dL WBC 8,000/mcL PMN 55% Plt 80,000/mcL MVC 92 fL MCH 31 pg MCHC 30 g/dL RDW 16%
- 51. Primary myelofibrosis Hct 28%Hb 9 g/dL WBC 8,000/mcL PMN 55% Plt 80,000/mcL MVC 92 fL MCH 31 pg MCHC 30 g/dL RDW 16%
- 52. AML Hct 22% Hb7 g/dL WBC 40,000/mcL Blast 90% Plt 30,000/mcL MVC 92 fL MCH 31 pg MCHC 30 g/dL RDW 14%
- 53. AML Hct 22% Hb7 g/dL WBC 40,000/mcL Blast 90% Plt 30,000/mcL MVC 92 fL MCH 31 pg MCHC 30 g/dL RDW 14%
- 54. Lymphoma leukemic phase Hct30% Hb 10 g/dL WBC 4,000/mcL PMN 80% Plt 120,000/mcL MVC 92 fL MCH 31 pg MCHC 30 g/dL RDW 14%
- 55. Lymphoma leukemic phase Hct30% Hb 10 g/dL WBC 4,000/mcL PMN 80% Plt 120,000/mcL MVC 92 fL MCH 31 pg MCHC 30 g/dL RDW 14%
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Editor's Notes
- #14 RBC repulse each other with negative charge in their surface.
- #15 Target cells have increased membrane (in liver disease) or decreased Hb (in thalassemia of iron deficiency).
- #16 Spherocyte loss their membrane constantly thus do not have enough membrane to stay in doughnut shape.
- #17 Schistocyte/fragmented RBC are caused by mechanical trauma to RBC. Heart valve, fibrin, abnormal vessel, etc.
- #18 Oxidative stress that exceed capability of RBC’s reduced glutathione cause injury to RBC membrane and leakage of Hb.
- #19 Burr cell is found in uremia.
- #20 Spur cell can be found in liver disease. Caused by excess cholesterol deposited in RBC membrane.
- #21 Tear drop cell happen when RBC squeeze through fibrosis in marrow. Fibrosis may be caused by PMF, solid tumor, etc.
- #22 With enormous molecule of IgM bind to membrane, RBC agglutinate into a large clump.
- #23 High concentration of positive-charge globulin negates anion repulsion of RBC. So RBC come to each other like a stack of (four or more) coins.