Peripheral Blood Smear Examination. Momtazmanesh MD. Ped. Hematologist & Oncologist Loghman General Hospital

Transcription

1

2 1395 Peripheral Blood Smear Examination Momtazmanesh MD. Ped. Hematologist & Oncologist Loghman General Hospital

3 Peripheral Blood Smear A peripheral blood smear is a snapshot of the cells that are present in the blood at the time that the sample is obtained.

4 When to Get Tested? When CBC results are abnormal. (flags) When a deficiency, disease, or disorder that can affect blood cell production is suspected. As a quality control tool for the results of CBCs.

5 Blood Smear prepration and staining: 1-Within 3 hours 2-Tradition wedge smear 3-Romanowsky stain (usually Wright's, Giemsa)

6 Momtazm anesh M.D.

7 Making and Staining a Blood Smear Place a drop of blood approximately 4 mm in diameter on the slide (near the end) Spread the drop by using another slide (called here the spreader ) placing the spreader at a 45 angle and BACKING into the drop of blood.

8

9 PBS To make a short smear, hold the spreader at a steeper angle, and to make a longer smear, hold it closer to the drop. Prevent blood from reaching the extreme edges of the slide. A smear with wavy lines or blanks spots should be discarded, and a new smear made.

10

11

12

13

14

15 Evaluation of Blood Cells Selection of a suitable area Traditional sequence: White cells Red cells Platelets Parasites

16

17

18

19 Evaluation of White Blood Cells Total counts Diff. counts I:T ratio Abnormal WBCs

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54 Pelger Huet Momtazmanesh M.D.

55

56 Red Blood Cells Size Color Shape Arrangement Inclusions Young RBCs

57

58

59

60

61

62 Hypochromia & microcytosis Iron deficiency anemia Thalassemia, α or β Sideroblastic anemia Chronic disease Infection Inflammation Cancer Lead toxicity Hemoglobin E trait

63

64 Macrocytosis Normal newborn Megaloblastic anemias Post-splenectomy Liver disease Hereditary aplastic anemia Hypothyroidism

65

66 Target cells Thalassemic syndromes Hb C, SC, S-Thal, E, D Obstructive liver disease Postsplenectomy or hyposplenic states Severe iron deficiency LCAT (lecithin/cholesterol acyltransferase) deficiency: (corneal opacifications, proteinuria, target cells, moderately severe anemia) Abetalipoproteinemia

67

68 Spherocytes Hereditary spherocytosis ABO incompatibility Autoimmune hemolytic anemia Burns Posttransfusion G-6-PD Deficiency Microangiopathic hemolytic anemia (MAHA) SS disease Hypersplenism Pyruvate kinase deficiency Water-dilution hemolysis

69

70

71 Acanthocytes (spur cells) Liver disease DIC and other MAHA Postsplenectomy or hyposplenic state Vitamin E deficiency Hypothyroidism Abetalipoproteinemia: (fat malabsorption, retinitis pigmentosa, neurologic abnormalities) Malabsorptive states

72

73 Echinocytes (burr cells) Artifact Uremia Dehydration Liver disease Pyruvate kinase deficiency Peptic ulcer disease or gastric carcinoma Immediately after red cell transfusion Rare congenital anemias due to decreased intracellular potassium

74

75 Schistocytes Helmet, triangular shapes, or small fragments DIC & MAHA (HUS, TTP) Severe hemolytic anemia (e.g., G6PD deficiency) Prosthetic cardiac valve, abnormal cardiac valve, cardiac patch, coarctation of the aorta Connective tissue disorder (e.g., SLE) Kasabach Merritt syndrome Purpura fulminans Renal vein thrombosis Homograft rejection Uremia, acute tubular necrosis, glomerulonephritis Malignant hypertension

76

77 Elliptocytes Hereditary elliptocytosis Iron deficiency (increased with severity, hypochromic) SS disease & SA trait Thalassemia major Severe bacterial infection Leukoerythroblastic reaction Megaloblastic anemias Any anemia may occasionally present with up to 10% elliptocytes Malaria

78

79 Teardrop cells Newborn Thalassemia major Leukoerythroblastic reaction Myeloproliferative syndromes

80

81 Stomatocytes Normal (in small numbers) Hereditary stomatocytosis Artifact Thalassemia Acute alcoholism Rh null disease (absence of Rh complex) Liver disease Malignancies

82

83 Blister cells G6PD deficiency (during hemolytic episode) SS disease Pulmonary emboli

84

85

86

87

88

89

90

91 Basophilic stippling Hemolytic anemias (e.g., thalassemia trait) Iron-deficiency anemia Lead poisoning

92

93

94 Cabot s Ring bodies Pernicious anemia Lead toxicity

95

96 Howell Jolly bodies Postsplenectomy or hyposplenia Newborn Megaloblastic anemias Dyserythropoietic anemias A variety of types of anemias (rarely iron-deficiency anemia, hereditary spherocytosis)

97

98

99 Heinz bodies G6PD Deficiency Normal in newborn Thalassemia (alpha) Asplenia Chronic liver disease Heinz body hemolytic anemia

100

101

102

103

104

105

106

107

108 Nucleated red blood cells Not normal in the peripheral blood beyond the first week of life Newborn (first 3 4 days) Intense bone marrow stimulation Hypoxia (especially postcardiac arrest) Acute bleeding Severe hemolytic anemia (e.g., thalassemia, SS hemoglobinopathy) Congenital infections (e.g., sepsis, congenital syphilis, CMV, rubella)

109

110

111 Leukoerythroblastic reaction extramedullary hematopoiesis and bone marrow replacement; most commonly: Leukemia Solid tumor Fungal and mycobacterial infection

112

113

114

115

116 Platelet Normal & Abnormal

117

118

119

120

121

122

123 Bernard-Soulier Syn.

124 Grey Platelet Syndrome

125

126 Bone Marrow Aspiration

127 Normal Bone Marrow

128 BMA in ITP

129

130

131

132

133

134

135

136 Q Momtazmanesh M.D.

137

138

139

140

141

142

143

144

145

146

147

148

149

150

151

152

153

154

155

156

157

158

159

160

161

162

163

164

165 myeloblast

166

167

168

169

170

171

172

173

174

175

176

177

178

179

180

181

182

183 Bernard-Soulier Syn.

184

185

186

187