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examination
INTRODUCTION
• Peripheral blood smear is a very important tool inthe
hematology lab
• It provides rapid, reliable access to information about a
variety of hematologic disorders
• Examination of the peripheral blood smear is an
inexpensive but powerful diagnostic tool in both children
and adults
• The smear offers a window into the functional status
of the bone marrow
INDICATION FOR PERIPHERALSMEAR
Abnormal CBC
Features suggestive of anemia, unexplained jaundice, or both.
• Lymphocyte Blue
• Metamyelocyte Pink
• Monocyte Grey–blue
• Myelocyte Pink
• Neutrophil Pink/orange
• Promyelocyte Blue
• Basophil Blue
PBS examination - preliminary
Biconcave disc
Diameter : 7 ~ 8 μm
Average volume : 90 fl.
Central pallor occupy 1/3 rd of total size
Approx same as nucleus of mature lymphocyte
RED CELLABNORMALITY
POSSIBLEPATHOLOGY
HIGH
MEGALOBLASTIC
RETICULOCYT LIVER POST HYPOTHYROIDISM
PROCESS DIESEASE SPLENECTOMY
E COUNT
HEMOLYTIC
OVAL CHRONIC
ANEMIA / ACUTE
MACROCYRTES ALCOHOLISM
BLOODLOSS
FOLATEAND B12
DEFICIENCY
NORMOCYTES
• NORMOCHROMIA
• HYPOCHROMIA
• HYPERCHROMIA
• POLYCHROMASIA
NORMOCHROMIA
• The term Normochromic indicates the red cell is essentially high
in color
• A normochromic erythrocyte has a well hemoglobinized
cytoplasm with a small but distinct zone of central pallor.
• The central pallor does not exceed 3µm .
• The term normochromic is used to describe the anemia with a
normal MCHC, and MCH and when used in conjunction with
MCV the anemia is described as NORMOCYTIC /
NORMOCHROMIC anemia .
HYPOCHROMIA
E.g. E.g.
Neutrophils Lymphocyte
Basophil Monocyte
Eosionophil
POLYMORPHONUCLEAR
NEUTROPHILS
• 40 to 80 percent of total WBC
count(2.0–7.0 ×109/l )
• Diameter - 13 µm
• segmented nucleus and
pink/orange cytoplasm with
fine granulation(0.2-0.3µm)
stain tan to pink with Wright’s
• Lobes -2-5
• Neutrophils usually have
trilobed nucleus.
• small percent has four lobes
and occasionally five lobes.
BAND FORMS
• Toxic granulation-
increase in staining
density and number of
granules
• Seen with Bacterial
infections and other
inflammation
• Administration of G-CSF
• Anaplastic anemia
DOHLE BODIES
• Small, round or oval, pale blue-grey
structure
• Found at periphery of neutrophil.
• Contains Ribosomes and
Endoplasmic reticulum
• Seen in – Bacterial infection
• inflammation
• administration of G-CSF
• during pregnancy
• Pernicious anemia
• Myeloproliferative disorders
• Myelodysplastic disorders
• Cancer chemothrapy
EOSINOPHILS
• Normally 1-6%( 0.02–0.5×
109/l)
• Size- 12–17 µm
• Nucleus- Bilobed
(spectacle shaped)
• Cytoplasm- Pale blue
• Granules - Coarse
spherical gold/orange
Eosinopenia- seen with prolonged steroid
administration.
• Eosinophilia- allergic conditions hay fever, asthma
• severe eosinophilia- parasitic infection
• reactive eosinophilia
• Eosinophilic leukaemia
• Idiopathic hypereosinophilic syndrome
• T-cell lymphoma, B-cell lymphoma
and acute lymphoblastic leukaemia.
BASOPHILS
• Rarest <1%
• Nucleus segments fold up on eachother
resulting compact irregular dense
nucleus(closed lotus flower like)
• Granules-large, variable size dark blue
or purple often obscure thenucleus
• Granules are rich in histamine,
serotonin and heparin
• Increase in myeloproliferative disorder-
CML
MONOCYTES
• 2-10% of total wbc count
• Size- largest circulating leucocyte, 15–
18µm in diameter
• Cytoplasm- grey blue
• Nucleus- large , curved , horse shoe
shape
• No segmentation occur
• Chromatin- fine evenly distributed
• Increase in chronic infections and
inflammatory conditions such as
• Tuberculosis and Crohn’s disease ,
• Chronic myeloid leukaemias
• Acute leukaemias with a monocytic
component
• Infectious mononucleosis
LYMPHOCYTES
• 20-40% of total WBC count
• It is of two types
1. Small lymphocyte(6-10µm)
2. Large lymphocyte(12-15µm)
• Nucleus-single, sharply
defined, stain dark blue on Wright’s
stain
• Cytoplasm- Pale blue
• Large lymphocytes less densely stain
nuclei & abundant cytoplasm
• Few round purple(azure) granules are
present
• Lymphocytes predominate in the blood
films of infants and youngchildren.
REACTIVE LYMPHOCYTES
Schizont Gamatocyte
Ring or trophozoite Represent the fullgrown Certain schizont get
trophozoite modified and result in sexual
• Many cells infected – forms. Merozoite arising
same with more than Contain 12-24 merozoits
from single schizont are
one parasite Arranged in the form of either all males orfemales
rosette with yellowbrown
• Unoccupied portion by Microgamatocyte: Spherical.
pigment at thecenter
Cytoplasm lightblue
parasite shows a dotted
or stripped appearance Macrogamatocytes:
“Schuffner’s dot” spherical. Cytoplasmdeep
blue
Disadvantages of the Peripheral Blood Smear