Blood smear morphology

Basic understanding of blood smear interpretation.
For every medical students and you.

1. Basic Morphology Kaipol Takpradit,MD Department of Medicine Bhumibol Adulyadej Hospital

2. Introduction Peripheral Blood Smear Very simple investigation Provide useful informations The first to check when CBC show abnormal

3. How to make PBS

4. How to make PBS

5. Understanding PBS Morphology of cells result from physical property of cells Physic not Magic!!

6. Principle of PBS Find proper 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 (methylene blue) Azurophilia (oxidized methylene blue) Acidophilia (eosin) Neutrophilia (mixture of dye)

9. Wright’s stain Basic dye bind to acid Nucleic acid (DNA, RNA) Protein Acidic dye bind to base Cytoplasm Hemoglobin

10. RBC

11. Abnormal RBC

12. Abnormal RBC

13. Abnormal RBC

14. Abnormal RBC Hemoglobin leakage cells Ghost cell

15. Abnormal RBC Burr cells

16. Abnormal RBC Spur cell

17. Abnormal RBC Tear drop cell

18. Abnormal RBC Auto-agglutination

19. Abnormal RBC Rouleaux formation

20. 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

21. Complete blood count MCV = volume of RBC (fL) MCH = Amount of hemoglobin (pg) MCHC = Hb concentration in each cells RDW = variety of RBC size

22. MCV Normal 85 - 95 α 1 trait 70 + 8.7 α 2 trait 85 + 5.5 β trait 68 + 6.9 Hb E trait 84 + 5.1 Hb EE 73 + 5.7 Hb H disease 67 + 6.7 β /E thal 69 + 5.6 β thal 55 - 65

23. Complete blood count Hct is 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

24. Case demonstration

25. Iron deficiency anemia Hct 21% 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%

26. Iron deficiency anemia Hct 21% 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%

27. 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%

28. 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%

29. 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%

30. 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%

31. 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%

32. 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%

33. 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%

34. 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%

35. AIHA Hct 20% 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%

36. AIHA Hct 20% 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%

37. 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%

38. 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%

39. ITP Hct 37% Hb 12 g/dL WBC 8,000/mcL PMN 75% Plt 20,000/mcL MVC 85 fL MCH 31 pg MCHC 30 g/dL RDW 12%

40. ITP Hct 37% Hb 12 g/dL WBC 8,000/mcL PMN 75% Plt 20,000/mcL MVC 85 fL MCH 31 pg MCHC 30 g/dL RDW 12%

41. TTP Hct 30% Hb 10 g/dL WBC 8,000/mcL PMN 75% Plt 60,000/mcL MVC 91 fL MCH 31 pg MCHC 30 g/dL RDW 18%

42. TTP Hct 30% Hb 10 g/dL WBC 8,000/mcL PMN 75% Plt 60,000/mcL MVC 91 fL MCH 31 pg MCHC 30 g/dL RDW 18%

43. CLL Hct 28% Hb 9 g/dL WBC 50,000/mcL Lymph 80% Plt 190,000/mcL MVC 81 fL MCH 31 pg MCHC 30 g/dL RDW 13%

44. CLL Hct 28% Hb 9 g/dL WBC 50,000/mcL Lymph 80% Plt 190,000/mcL MVC 81 fL MCH 31 pg MCHC 30 g/dL RDW 13%

45. CML Hct 31% Hb 9 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%

46. CML Hct 31% Hb 9 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%

47. 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%

48. 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%

49. AML Hct 22% Hb 7 g/dL WBC 40,000/mcL Blast 90% Plt 30,000/mcL MVC 92 fL MCH 31 pg MCHC 30 g/dL RDW 14%

50. AML Hct 22% Hb 7 g/dL WBC 40,000/mcL Blast 90% Plt 30,000/mcL MVC 92 fL MCH 31 pg MCHC 30 g/dL RDW 14%

51. Lymphoma leukemic phase Hct 30% 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%

52. Lymphoma leukemic phase Hct 30% 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%

53. FIN