Leucocytes Identification

A.A.Wiradewi Lestari
METHOD OF PREPARING MANUAL
BLOOD SMEARS

Peripheral blood smears are made from anticoagulate blood

or from a fresh drop of blood from the syringe or a finger-
stick puncture.
A drop of blood is placed at one end of a glass slide. The
drop should be sufficiently large to produce a blood film of
at least 2.5 cm.
A second pusher slide is held at a 30-45 degree angle to
the smear slide. This slide is drawn back until it touches the
drop of blood. The blood spreads behind the pusher to
nearly the full width of the pusher slide.
 The pusher slide then is advanced smoothly and
quickly to produce a blood smear at least 2.5 cm
long that ends approximately 2 cm from the end
of the slide.
Moving the pusher slide forward too slowly
accentuates poor leukocyte distribution by
pushing larger cells, such as monocytes and
granulocytes, to the end and sides of the smear.
 Properly prepared smears should be of a wedge shape, with
only a slightly rounded end. Properly prepared smears have
a normal gradation from thick to thin. The edges of the
smear should not touch the slide edges.
The slide edge is an area where small numbers of large-size
malignant cells deposit, so this area should be available for
scanning.
Immature- mature
Reference Range :
Dewasa 5.000-10.000/uL
Neonatus 10.000-25.000/uL
1-7 tahun 6.000-18.000/uL
8-12 tahun 4.500-13.500/uL
Abnormal:

>10.000/uL leukositosis
< 5.000/uL leukopenia
10.000-15.000/uL leukositosis ringan
15.000-20.000/uL leukositosis sedang
20.000-50.000/uL leukositosis berat
>50.000/uL reaksi leukomoid
Blood element % of leuko- Size (rel. Cytoplasmic Nucleus
cytes to RBC) staining morphology

basophil 0 -1 10-14m Large, basophilic S-shaped, can be

(1 1,3) granules occluded
granules
eosinophil 1-3 12-17m Eosinophilic 2-3 lobes
(1,2 1,8) staining
granules
neutrophil Band: 2-6 10-15m small granules Band shaped,
Segment: 50-70 (1,1 1,5) Segmented,
polymorphic
lymphocyte 20-40 7-18m Basophilic, scant Round, acentric
(1 1,25) amount, no
granules

monocyte 2-8 12-20m Basophilic, no Large, variable,

(1,5 1,9) granules kidney
shaped
HITUNG JENIS LEUKOSIT
Prosedur

Seleksi area yg paling baik untuk evaluasi

Dengan lensa objektif 10 x perhatikan bagian yang cukup tipis dan rata
susunan eritrositnya, penyebaran leukosit memenuhi syaratcounting
area
Dengan lensa objektif emersi (100 x), menilai morfologi trombosit,
eritrosit, leukosit
Cara Melakukan Hitung Jenis
Pilih bagian yang cukup tipis dan penyebaran leukosit
merata

Mulai menghitung pada pinggir atas sediaan

pinggir bawah kekanan pinggir atas lagi dst

Lakukan terus sampai 100 sel leukosit, dihitung

menurut jenisnya

Catat juga kelainan morfologi pada leukosit

Jumlah setiap jenis sel dinyatakan dalam persen

Laporkan jika terdapat eritrosit berinti per 100 leukosit

hitung jenis dilakukan menggunakan 10 kolom, mengelompokkan tiap
10 sel yang dihitung, sampai terdapat 100 sel
Schilling Hemogram
 Schilling Hemogram

Sel 10 10 10 10 10 10 10 10 10 10 Jumlah

Basofil 0

Eosinofil I

Batang II

Segmen III III

I I
limfosit II III

Monosit I II

Jumlah 10 10 100
Melaporkan Hitung Jenis

Mulai dengan sel basofil, eosinofil, neutrofil

batang, neutrofil segmen, limfosit dan monosit
Nilai normal hitung jenis pada dewasa

- Basofil : 0-1 %
- Eosinofil :13%
- Neutrofil batang :26%
- Neutrofil segmen : 50 70 %
- Limfosit : 20 40 %
- Monosit :28%
 Basofilia: leukemia granulositik kronik
Eosinofilia: asma bronkial, askariasis
Neutrofilia: inf bakteri, intoksikasi
Limfositosis: inf virus
Monositosis: malaria
References

Young S.C.A., Poulsen K.B., Andersons Atlas of Haematology, 2 nd Ed,

Lippincott Williams and Wilkins
Pereira I., et all, Atlas of Pheriperal Blood, Lippincott Williams and
Wilkins
Rodak B.F., et all, Hematology : Clinical Principles and Applications, 4
th Ed, Elsevier