Indication of peripheral blood smear exmination:

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2 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.

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

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5 1. Abnormalities of Haemoglobin content:- Hypochromia Hyperchromia Anisochromia Polychromatophilia 2. Abnormalities of size of red cells:- Microcytosis Macrocytosis Anisocytosis

6 3. Abnormalities of shape of red cells ( Poikilocytosis ):- different abnormal shapes of RBC I. Elliptocytosis II. Spherocytosis III. Target cells IV. Schistocytosis V. Acanthocytois VI. Crenated cells VII. Sickled cells VIII. Leptocytes

7 4. Abnormalities of structure of red cells:- Basophilic stippling ( Punctate basophilia ) Howell- jolly bodies Cabot rings Pappenheimer bodies Malarial stippling Rouleaux formation Agglutination Nucleated red cells

8 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 days life span

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12 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.

13 Microcytic the average size of erythrocytes is smaller than normal

14 Macrocytic Note the hypersegmented neurotrophil and also that the RBC are almost as large as the lymphocyte. Finally, note that there are fewer RBCs.

15 Here. Elliptocytosis, Megaloblastic anaemia ELLIPTOCYTE

16 HS, AIHA, Thermal injury,burns, Chemical poisoning, Hypophosphataemia SPHEROCYTE

17 Uraemia,Pyruvatekin ase defi.,phosphoglycera te kinase defi. ECHINOCYTES

18 Disturbence in red cell cation composition Hereditary Stomatocytosis, Liver disease, Alcoholism STOMATOCYTE

19 Thalassemia Major, Microangiopathic Hemolytic anaemia, Cardiac Hemolytic anaemia

20 Sickle cell anemia

21 Thalassemia disorder, Sickle cell anaemia, Hb E & Hb C disease,liver disease, after splenectomy

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25 Terminology Description Condition Target cells Central hemoglobin; target-shaped Liver disease; thalassemia: Abnormal Hgb; iron deficiency Echinocyte Short spicules, equally-spaced Uremia, hypokalemia, artifact Acanthocyte Spiculated, irregular Liver disease (alcohol), Post-splenectomy Spherocyte anemia Spherical, no central pallor HS, Immune hemolytic Schistocyte 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

26 Rouleaux formation RBCs increased Agglutination Stacking of due to plasma proteins coating RBCs Antibody-mediated clumping, temperature mediated

27 Auto immune hemolytic anaemia

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32 NORMOCYTIC NORMOCHROMIC RBC MICROCYTIC HYPOCHROMIC R

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34 G6PD Deficiency

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36 Microcytic - Thalassaemia trait Normocytic - Lead poisoning Normo or micro - Sideroblastic anemia Macrocytic - Megaloblastic anemia

37 Post splenectomy Splenic atrophy Pernicious anaemia Coeliac disease

38 RING OF P.VIVAX

39 TROPHOZOITE OF P.VIVAX

40 MULTIPLE RINGS OF P.FALCI

41 GAMATOCYTE OF P.FALCI

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

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48 BLAST CELL

49 BASOPHIL Thank You MYELOBLAST MYELOCYTE

50 Platelets are small, 1-3 µm in diameter, purple structures with tiny irregular projection on surface.

51 Thrombocytopenia in malaria and dengue.

52 Clumps of platelets Platelet satellitism. Causes of false thrombocytopenia on automated heamatology analyzer: a)

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