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. 1) RBC series 2) WBC series 3) Platelets 4) Parasites 5) Other abnormal cells final diagnosis with advice

1. Abnormalities of Haemoglobin content:- Hypochromia Hyperchromia Anisochromia Polychromatophilia

2. Abnormalities of size of red cells:- 3. Abnormalities of shape of red cells ( ):- different abnormal shapes of RBC

I. Elliptocytosis II. III. Target cells IV. Schistocytosis V. Acanthocytois VI. Crenated cells VII. Sickled cells VIII. Leptocytes 4. Abnormalities of structure of red cells:- • ( Punctate basophilia ) •Howell- jolly bodies • • •Malarial stippling • formation •Agglutination •Nucleated red cells •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

Hypochromic Microcytic

The RBC‘s here are smaller than normal and have an increased zone 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. Microcytic

the average size of erythrocytes is smaller than normal Macrocytic

Note the hypersegmented neurotrophil and also that the RBC are almost as large as the lymphocyte. Finally, note that there are fewer RBCs.  Here. Elliptocytosis, Megaloblastic anaemia

ELLIPTOCYTE  HS, AIHA, Thermal injury,Burns, Chemical poisoning,  Hypophosphataemia

SPHEROCYTE  Uraemia,Pyruvatekin ase defi.,Phosphoglycera te kinase defi.

ECHINOCYTES  Disturbence in red cell cation composition  Hereditary Stomatocytosis, Liver disease, Alcoholism

STOMATOCYTE  Thalassemia Major, Microangiopathic Hemolytic anaemia, Cardiac Hemolytic anaemia  Sickle cell anemia  Thalassemia disorder, Sickle cell anaemia, Hb E & Hb C disease,Liver disease, after splenectomy

 Terminology Description Condition

 Target cells Central hemoglobin; target-shaped Liver disease; thalassemia: Abnormal Hgb; iron deficiency

Short spicules, equally-spaced Uremia, hypokalemia, artifact

Spiculated, irregular Liver disease (alcohol),  Post-splenectomy

 Spherocyte Spherical, no central pallor HS, Immune hemolytic anemia   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  Rouleaux formation Stacking of RBCs due to increased plasma proteins coating RBCs  Agglutination Antibody-mediated clumping, temperature mediated  Auto immune hemolytic anaemia

MICROCYTIC HYPOCHROMIC RBC

NORMOCYTIC NORMOCHROMIC RBC

 G6PD Deficiency

 Microcytic - Thalassaemia trait

 Normocytic - Lead poisoning

 Normo or micro -

 Macrocytic - Megaloblastic anemia  Post splenectomy  Splenic atrophy  Pernicious anaemia  Coeliac disease RING OF P.VIVAX TROPHOZOITE OF P.VIVAX MULTIPLE RINGS OF P.FALCI GAMATOCYTE OF P.FALCI

 Cells with 5 or more lobes are considered hypersegmented, e.g. megaloblastic changes  Uraemia  After cytotoxic drug treatment esp methotrexate

BLAST CELL BASOPHIL

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MYELOBLAST

MYELOCYTE Platelets are small, 1-3 µm in diameter, purple structures with tiny irregular projection on surface.  Thrombocytopenia in malaria and dengue. Clumps of platelets Platelet satellitism.

 Causes of false thrombocytopenia on automated heamatology analyzer:  a)