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![Abnormalities of Shape
6.Acantocytes
• RBCS with fewer thorn like projection of
varying sizes and variable in number
• more blunted than Echinocytes.
Seen in
• Disorders of liquid metabolism
• chronic liver disease ] Acquired.
• Spur cell anemia](https://image.slidesharecdn.com/peripheralsmearnew-140817074554-phpapp01/85/Peripheral-smear-29-320.jpg)
Uploaded byFarasat Umar
Peripheral smear
This document provides information about performing and interpreting a peripheral blood smear. It discusses examining red blood cells for morphology, abnormalities in shape and distribution, and inclusions. White blood cell morphology of neutrophils, eosinophils, basophils, monocytes, and lymphocytes is also described. Platelet morphology and abnormalities in platelet count are briefly covered. The preparation, staining, and examination process for a peripheral blood smear is outlined.
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Peripheral smear
- 1.
- 2. Blood film isexamined for • DLC • General assessment of cell counts • RBCs morphology • WBCs morphology • Platlet morphology • Study of other defects like rouleaux formation, agglutination, red cells inclusions etc
- 3. Preparation • Place asmall drop of blood on central line 1 cm from one end • Place a spreader at 45o angle in front of blood • Push the spreader forward by the rapid ,smooth and straight movement • Allow the film to dry in air
- 4. Staining • Most commonlyused stains are • Giemsa • Jenner’s Stain • Wright’s stain • Leishman’s stain
- 5. Giemsa Staining • Fixair dried blood film with methanol for 5-10 minutes • Transfer the film to a jar containing Giemsa stain(1:10 dilution) for 10-15 minutes • Wash with buffered water • Allow to stand in a jar containing buffered water for 3-5 minutes • Dry it in a vertical position Examination: • First examined under low power(*10) objective to get an idea of quality of film • Then select a suitable area and examine with(*40) objective
- 6. Types of cells •RBCs • WBCs • Platlets
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- 8. RBC Morphology • Normal: •Circular discs-6-4Um • Equal to size of nucleus of small lymph • Bright red at periphery • Central1/3rd is pale
- 9. Abnormalities of Distribution •Rouleaux formation – Infections – Multiple Myeloma • Agglutination • incompatible blood transfusion
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- 12. Abnormalities of Colour •Hypochromia- IDA and Thalasemia • Hyperchromia- • Spherocytes • Macrocytes • Target Cells: Central hemoglobin area surrounded by a pale ring and then hemoglobin in peripheral area • Dimorphism :Two populaions of RBCs in the same blood film-one normal and other abnormal • Seen in –sideroblastic anemia • After blood transfusion • Patients receiving hematonics
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- 16. Anisocytosis Size of RBCsvaries in same film • Microcytosis • Iron deficiency anemia • Thalasemia • Sideroblastic Anemia • Macrocytosis • Megaloblastic Anemia • Liver disease • Aplastic Anemia • Alchol Excess • Tretament with Hydroxyurea • Hyperglycemia • Obstructive airway disease
- 17.
- 18. Poikilocytosis shape of RBCsvaries/abnormal Shaped RBCs seen in • IDA, • Megaloblastic anemia, • Myelodysolasticsyndrome, • thalasemia, • myelofibrosis etc.
- 19. Abnormalities of Shape 1.Spherocytes SphericalRBCs Seen in : • Hereditary Spherocytosis • Immune Hemolytic anemias • ABO hemolytic disease of newborn • Bacterial toxins e.g Cl.Perferingens • In Banked blood
- 20.
- 21. Abnormalities of Shape 2.Elliptocytesand ovalocytes • 10% seen in normal blood fil(tail end) Seen in : • Iron deficiency anemia(pencil Cells) • Megaloblastic Anemia • Myelofibrosis(tear drop cells)
- 22.
- 23. Abnormalities of Shape 3.Stomatocytes: •Mouth like slit in RBCs • Few in normal blood film • Increase in alcoholism • Liver disease • Hereditary membrane defects
- 24. Abnormalities of Shape 4.Schistocytes: •Fragmented RBCs of various shapes and sizes e.g helmet cells Seen in: • IDA • Megaloblastic anemia • Thalasemia • DIC • Microangiopathy
- 25.
- 26. Numerous fragmented RBC's.Numerousfragmented RBC's. “Helmet" cells. “Schistocytes"“Helmet" cells. “Schistocytes"
- 27. Abnormalities of Shape 5.Echinocytesand burr cells: • RBCs with evenly distributes blunt spicules. Burr cells are echinocytes with reversible spicules Seen in • after prolonged standing of blood at room temp • when film is made on an oily slide
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- 29. Abnormalities of Shape 6.Acantocytes •RBCS with fewer thorn like projection of varying sizes and variable in number • more blunted than Echinocytes. Seen in • Disorders of liquid metabolism • chronic liver disease ] Acquired. • Spur cell anemia
- 30.
- 31. Abnormalities of Shape 7.Sicklecells • Thin, elongated, deeply staining RBCS with elongated ends. • Seen in sickle cell disease.
- 32.
- 33. Inclusions in RBCS 1.Hbcrystals : Hb c and Hbs form crystals inside the RBCS 2.Howell – Jolly bodies: small rounded , reddish to blue fragments of nucleus ,<1 um in diameter . May be single or multiple • splenectomy • splenic atrophy • alcoholism • sickle cell anemia and megaloblastic anemia
- 34.
- 35. Inclusions in RBCS 3.Basophilic stippling or punctuate basophilia : • Fine to coarse , deep blue to purple , small and multiple inclusions of varying sizes. • Represent aggregated ribosomes. • 1. Thalasemia 2. megaloblastic anemia 3.liver disease 4. lead poisoning 5.Infections.
- 36.
- 37. Inclusions in RBCs 4.Pappenheimerbodies; • small , dark staining , irregular granules of hemosiderin , near the periphery. • Seen in • 1. Sideroblastic anemia 2.thalasmia and 3. dyserythropoietic anemia.
- 38. Inclusions in RBCs 5.CabotRings: • Thin, reddish blue,ring like structure.it may be twisted to form structure of 8 • Seen in: Severe anemia, megaloblastic anemia, lead poisoning, dyserythropoeitic anemia • Parasites e.g malaraial parasite
- 39.
- 40. WBC Morphology 1. Neutrophils •13 um in diameter • segmented nucleus (3-5 lobes) • Hypersegmented nucleus -megaloblastic anemia • Only 8% stab form ( unsegmented nucleus) in normal blood. • Normaly azurophilic, small, evenly distributed granules. • Hypergranular cells-Toxic granulations- bacterial infections • Hypogranuler cells - in myelodysplastic syndrome.
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- 44. WBC Morphology 2.Eosinophils • Bilobed, golden/orange granules in allergic conditions and parasitic infection
- 45.
- 46. WBC Morphology 3.Basophils • Bilobednucleus , Dark blue granules obscure nucleus. < 1 % in normal blood ↑ in CML.
- 47.
- 48. WBC Morphology 4.Monocytes • largestof WBC . Bluish grey cytoplasm with ground glass appearance in chronic infections + some leukemias
- 49.
- 50. WBC Morphology 5.Lymphocytes • 90%smalllymphocytes, • 10% large lymphocytes
- 51.
- 52. Morphology of Platelets •Small(1-3µm) • Discoid shape • No nucleus • Increase count (thrombocythemia) ---in acute inflammation or stress • Decreased platelets (thrombocytopenia)--- in viral infections