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Peripheral Blood Smear Examination: A blood smear, peripheral blood smear or blood film is a thin layer of blood smeared on a glass microscope slide and then stained in such a way as to allow the various blood cells to be examined microscopically.
What abnormalities can be seen on a peripheral blood smear examination?
Anisocytosis
• Variations in the size of red blood cells.
• Seen in iron deficient anaemia, megaloblastic anaemia, moderate or severe thalassemia, post-transfusion and sideroblastic anaemia.
Poikilocytosis
• Variations in the shape of red blood cells.
• Seen in iron deficient anaemia, thalassaemia and sideroblastic anaemia.
Microcytosis
• Red blood cells smaller than their normal size ( <75 fL).
• Seen in iron deficient anaemia, thalassaemia and sideroblastic anaemia.
Macrocytosis
• Red blood cells larger than 100 fL.
• Seen in vitamin B12 and folic acid deficiency.
Hypochromia
• Red cells having lower haemoglobin as judged by their appearance under microscopy. The central pallor is more than one-third the diameter of red cell.
• Seen in iron deficient anaemia, thalassaemia and sideroblastic anaemia.
Polychromasia
• Red blood cells show colour variability; some (usually the majority) are usual red color, while others are bluish.
• Associated with reticulocytosis.
Basophilic Stippling or Punctate Basophilia
• Presence of scattered deep blue dots in the cytoplasm of red blood cells with Romanowsky staining. These represent altered ribosomes.
• Seen in pathologically damaged young red cells.
• Also seen in severe anaemia, 13-thalassaemia and chronic lead poisoning.
Target Cells
• Flat red cells with a central mass of haemoglobin (dense area), surrounded by a ring of pallor (pale area) and an outer ring of haemoglobin (dense area).
• Seen in chronic liver diseases, hyposplenism and haemoglobinopathies.
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Howell-Jolly Bodies
• These are remnants of nuclear material left in the erythrocyte after the nucleus is extruded. They are normally removed by the spleen.
• Appear as solitary round mass, relatively large within haemoglobinized portion of red blood cell; on Wright’s stain, appear dark blue or purple.
• Seen in non-functioning or absent spleen and megaloblastic anaemias.
Heinz’s Bodies (Ehrlich’s Bodies)
• Formed from denatured aggregated haemoglobin.
A submembranous small round mass in red cells seen on supravital stain; not seen with routinely stained film.
• Seen in thalassaemia, haemolysis in glucose-6-phosphate dehydrogenase (G6PD) deficiency, asplenia and chronic liver disease
Acanthocytes or Spur Cells
• Red blood cells showing irregular spicules.
• Seen in abetalipoproteinaemia, advanced liver disease, and hyposplenism.
Burr Cells
• Red blood cells showing regularly placed spicules.
• Seen in uraemia, and post-transfusion.
Schistocytes
• These are fragmented red cells (with central pallor often missing) and are seen in intravascular haemolysis.
Spherocytes
• These are small, densely packed red cells with loss of central pallor and occur in hereditary spherocytosis and immuno haemolytic anaemias.
Microspherocytes
• Red blood cells are both hyperchromic and significantly reduced in size and diameter; occur in low numbers in patients with spherocytic haemolytic anaemia. Typical of bums and of microangiopathic haemolytic anaemia.