The document outlines the indications and methodology for peripheral smear examination, which assesses the morphology and cellularity of blood components. It details the evaluation of red blood cells, white blood cells, and platelets, along with various abnormalities such as rouleaux formation, agglutination, and multiple types of cells observed in different conditions. The document also provides specific descriptions for various blood cell shapes and their clinical significance.

1. CLIP
DR . NANDITA S

2. PERIPHERAL SMEAR REPORTING

3. INDICATIONS OF PERIPHERAL SMEAR
EXAMINATION
To assess the cellularity of the different blood elements
To study the morphology of these blood elements
To look for blood parasites
• To study the response of the body to various disease processes

4. • Peripheral smear has 3 parts
- Head
- Body
- Tail
• Best place to study morphology is where the cells are well
separated out and not overlapping .
• At the junction of body and tail

5. LOW POWER
• To get an idea of the quality of the smear
• The number, distribution and staining of the leucocytes
• Red cell agglutination and rouleaux formation
• Extracellular parasites such as microfilaria
• To select a good area where RBCs are just touching each
other
Put a drop of oil and change to oil immersion objective.

6. Cellular elements are studied in the following order
• RBCs
• WBCs
• Platelets

7. RBC
• Rouleaux formation/agglutination
• Size
• Hb content
• Shape
• Immature RBC
• Inclusion bodies
• Intracellular parasites

8. Rouleaux formation
Rouleaux formation
(pile of coins appearance)
• Seen in Multiple Myeloma
Agglutination
• Seen in Autoimmune hemolytic
anemia

9. Size
• A normal red cell is about 7.2 µ
in diameter
• In the peripheral smear they are
compared with small mature
lymphocytes

10. • When the variation in size is
greater than normal, it is
called Anisocytosis.

11. Hb Content
• Normal red cells have a small central 1/3 area of pallor because
of their biconcave shape.
• When this normal pallor is increased it is called hypochromia
and correlates with a decrease in the amount of hemoglobin.

12. Microcytic Hypochromic
• When the size of the
RBC is smaller than
normal
• Seen in Iron
deficiency anemia
Macrocyte
• When the size of RBC
larger than normal
• Seen in Megaloblastic
anemia

13. Shape
• Normal red cells are biconcave in shape and appear circular on
a smear as they are flattened out.
• Variation in shape is known as Poikilocytosis.

14. Spherocytes
• Spherocytes are red cells
showing no central area of
pallor.
• They are smaller than normal
RBCs and stain darker.
• Seen in Hereditary
spherocytosis

15. Target cells
• Cells which show a central
stained area and a
peripheral stained rim with
unstained cytoplasm in
between.
• They are thinner than
normal cells.
• Seen in Thalassemia

16. Sickle cells
• RBCs assume this
shape due to
crystallization of the
abnormal hemoglobin
(HbS) when oxygen
tension is reduced.
• Seen in Sickle cell
disease.

17. Elliptocytes
• Elliptical or oval in
shape
• Seen in Hereditary
Elliptocytosis
Tear drop cells
• Seen in
myelofibrosis.

18. Schistocytes
• Fragmented red cells
• Seen in Microangiopathic
hemolytic anemia
Acanthocytes
• These are red cells with
projections of varying size
• Seen in
Abetalipoproteinemia

19. Burr cells
• These are red cells with
projections on the surface
which are uniform sized
• Seen in Uremia.

20. Immature RBC
Polychromasia
• Term used for red cells which
stain pinkish blue with
Romanowsky stain.
• Larger than normal RBC
• Seen in Hemolysis
Normoblasts
• Normoblasts are seen in
the peripheral circulation
in accelerated
erythropoiesis
• Seen in Hemolytic Anemia

21. Inclusion bodies
• HowelI Jolly bodies
• Basophilic stippling
• Cabot rings

22. Howell Jolly bodies
• Howell–Jolly bodies are
nuclear remnants.
• They are small, round
cytoplasmic inclusions that
stain purple on a
Romanowsky stain
• Seen in Megaloblastic anemia

23. Basophilic stippling
• These are small blue or black
granules in red cells which
are actually aggregates of
ribosomes.
• Seen in Megaloblastic Anemia

24. Cabot rings
• These are pale staining rings
or figures of eight and are
thought to be remnants of the
nuclear membrane.
• They are seen in
Megaloblastic anemia

25. Intracellular parasite
Seen in
1. Malaria
2. Bancrofti

26. WBC
• Count
• Distribution
• Predominant cell
• Immature cells
• Atypical cells

27. • Normal WBC count is 4000-11,000/cumm
• Leucocytosis-an increase in the total count to values more than
11,000/cumm
• Leucopenia-decrease in the total count to less than 4000
cells/cumm
• The tail end of the smear has to be screened before remarking
that the smear shows leucopenia.

28. • The differential WBC count should be done under oil immersion
• Differential WBC count is best done in the same area of the
smear where RBC morphology is best

29. Normal Differential count
Neutrophils 40-70%
Lymphocytes 20-40%
Monocytes 2-10%
Eosinophils 1-6%
Basophils 0-1%

30. Immature cells

31. Atypical/activated lymphocytes
• Atypical lymphocytes are seen in
Infectious mononucleosis and
other viral infections

32. Platelets
• Count
• Distribution: Single / Clumps
• Abnormal forms

33. Count
• In a normal peripheral smear, every oil immersion field will have
8-25 platelets on an average

34. • Normal platelet count is 150,000-400,000/µl
• Increase in platelet count more than 4,00000/µL –
Thrombocytosis
• Decrease in platelet count less than 1,50000/ µL-
Thrombocytopenia

35. Distribution
• Seen in clumps or scattered
Abnormal forms
• Large platelets may be seen
in Immune thrombocytopenic
purpura

36. THANK YOU