blood smear morphology

Basic MorphologyKaipol Takpradit,MD

Department of Medicine Bhumibol Adulyadej Hospital

Introduction

Peripheral Blood Smear

Very simple investigation

Provide useful informations

The first to check when CBC show

abnormal

How to make PBS

Understanding PBS

Morphology of cells result from physical

property of cells

Physic not Magic!!

Principle of PBS

Find proper area

Known relative cell size

Known how cell’s composition stain

Known normal

Romanowsky stain

Acidic + basic = neutral dye staining

(Eosin Y + methylene blue) in methanol

= Wright’s stain

Wright’s stain

Basophilia (methylene blue)

Azurophilia (oxidized methylene blue)

Acidophilia (eosin)

Neutrophilia (mixture of dye)

Wright’s stain

Basic dye bind to acid

Nucleic acid (DNA, RNA)

Protein

Acidic dye bind to base

Cytoplasm

Hemoglobin

Abnormal RBC

Abnormal RBCHemoglobin leakage cells

Ghost cell

Abnormal RBC

Burr cells

Abnormal RBC

Spur cell

Abnormal RBC

Tear drop cell

Abnormal RBC

Auto-agglutination

Abnormal RBC

Rouleaux formation

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


MCV = volume of RBC (fL)

MCH = Amount of hemoglobin (pg)

MCHC = Hb concentration in each cells

RDW = variety of RBC size

MCVNormal 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


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

Case demonstration

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%

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%

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%

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%

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%

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%

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%

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%

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%

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%

CMLHct 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%

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%

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%

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%

blood smear morphology

Education

rbc membrane

rbc agglutinate

rbc squeeze

abnormal rbc burr cells

abnormal rbc target

abnormal rbc spherocyte

volume of rbc flmch

variety of rbc sizemcvnormal85