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Peripheral Blood Smear Examination: What abnormalities can be seen on a peripheral blood smear examination?

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.

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.

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