indication of peripheral blood smear-pheripheral smear examination.pdf · indication of peripheral...
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Indication of peripheral blood smear
exmination:1. For carried out differential WBC count.
2. For differential diagnosis of anemia.
3. For detection of parasites.
4. For diagnosis of leucemoid reaction.
5. For diagnosis and differential diagnosis of leukemia.
6. For detection of platelet abnormalities.
7. For diagnosis of conditions like infectious mononucleosis.
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1) RBC series
2) WBC series
3) Platelets
4) Parasites
5) Other abnormal cells
final diagnosis with advice
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1. Abnormalities of Haemoglobin content:-
HypochromiaHyperchromiaAnisochromiaPolychromatophilia
2. Abnormalities of size of red cells:-
MicrocytosisMacrocytosisAnisocytosis
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3. Abnormalities of shape of red cells ( Poikilocytosis ):-
different abnormal shapes of RBC
I. Elliptocytosis
II. Spherocytosis
III. Target cells
IV. Schistocytosis
V. Acanthocytois
VI. Crenated cells
VII. Sickled cells
VIII. Leptocytes
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4. Abnormalities of structure of red cells:-
•Basophilic stippling ( Punctate basophilia )
•Howell- jolly bodies
•Cabot rings
•Pappenheimer bodies
•Malarial stippling
•Rouleaux formation
•Agglutination
•Nucleated red cells
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•No nucleus, enzyme packets•Biconcave discs – Haem + Gl•Center 1/3 pallor•Pink cytoplasm (Hb filled)•Cell size 7- 8 µ - capill. 2 µ•EM pathway, HMP•Negative charge – no phago•Na less, K more inside•100-120 days life span
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Hypochromic Microcytic
The RBC‘s here are smaller than normal and have an increasedzone of central pallor. This is indicative of a hypochromic (less hemoglobin in each RBC) microcytic (smaller size of each RBC) anemia. There is also increased anisocytosis.
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Microcytic
the average size of erythrocytes is smaller than normal
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Macrocytic
Note the hypersegmented neurotrophil and also that the
RBC are almost as large as the lymphocyte. Finally, note
that there are fewer RBCs.
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Here. Elliptocytosis,
Megaloblastic
anaemia
ELLIPTOCYTE
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HS, AIHA, Thermal
injury,Burns,
Chemical poisoning,
Hypophosphataemia
SPHEROCYTE
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Uraemia,Pyruvatekin
ase
defi.,Phosphoglycera
te kinase defi.
ECHINOCYTES
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Disturbence in red
cell cation
composition
Hereditary
Stomatocytosis, Liver
disease, Alcoholism
STOMATOCYTE
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Thalassemia Major,
Microangiopathic
Hemolytic anaemia,
Cardiac Hemolytic
anaemia
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Sickle cell anemia
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Thalassemia
disorder, Sickle cell
anaemia, Hb E & Hb
C disease,Liver
disease, after
splenectomy
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Terminology Description Condition
Target cells Central hemoglobin; target-shaped Liver disease; thalassemia: Abnormal
Hgb; iron deficiency
Echinocyte Short spicules, equally-spaced Uremia, hypokalemia, artifact
Acanthocyte Spiculated, irregular Liver disease (alcohol), Post-splenectomy
Spherocyte Spherical, no central pallor HS, Immune hemolytic anemia
Schistocyte Fragmented RBC, helmet cells MAHA, burns
Ovalocyte Oval/elliptical shaped Hereditary elliptocytosis, Megaloblastic anemia
Sickle cell bipolar spiculated shape Hgb S-containing “banana” shaped hemoglobinopathy
Teardrop cell single elongated extremity Myelophthistic changes
Bite cells Irregular gap in membrane G6PD deficiency
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Rouleaux formation Stacking of
RBCs due to
increased plasma proteins coating RBCs
Agglutination Antibody-mediated
clumping,
temperature mediated
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Auto immune
hemolytic anaemia
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NORMOCYTIC NORMOCHROMIC RBC
MICROCYTIC HYPOCHROMIC RBC
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G6PD Deficiency
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Microcytic -Thalassaemia trait
Normocytic - Lead poisoning
Normo or micro -Sideroblastic anemia
Macrocytic -Megaloblastic anemia
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Post splenectomy
Splenic atrophy
Pernicious anaemia
Coeliac disease
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RING OF P.VIVAX
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TROPHOZOITE OF P.VIVAX
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MULTIPLE RINGS OF P.FALCI
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GAMATOCYTE OF P.FALCI
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Cells with 5 or more
lobes are considered
hypersegmented, e.g.
megaloblastic
changes
Uraemia
After cytotoxic drug
treatment esp
methotrexate
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BLAST CELL
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Thank You Thank You
MYELOCYTE
BASOPHIL
MYELOBLAST
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Platelets are small, 1-3 µm in diameter,
purple structures with tiny irregular
projection on surface.
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Thrombocytopenia in malaria and dengue.
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Causes of false thrombocytopenia on automated heamatology analyzer:
a)
Clumps of platelets Platelet satellitism.