Role of peripheral blood
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In the work-up of a disease, the peripheral smear gives a very good information of what disease the patient may be suffering from. It also gives direction for further evaluation, all impacting the treatment and well being of the patient.
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Role of peripheral blood
- 1. Role of Peripheral blood smear examination in diagnostic work-up Dr K Richards MD(Path);DTCD Consultant Pathologist- Hematology Yashoda Hospital
- 2. Why do a peripheral blood film examination?
- 10. Anisocytosis • abnormal erythropoiesis • non-specific feature • either macrocytes or microcytes or both
- 11. Poikilocytosis • abnormal erythropoiesis • non-specific feature • megaloblastic anemia, • iron deficiencyanemia, • thalassemia, • myelofibrosis, • MDS • Congenital dyserythropoietic anemia
- 12. Microcytes • defect in hemoglobin formation • characteristic of iron deficiency anemia • thalassemia • severe cases of anemia of chronic disease • sideroblastic anemias
- 13. Macrocytes • classical in megaloblastic anemia • aplastic anemia • MDS • Alcoholics • Chronic liver disease • Hydroxyurea
- 14. Basophilic stippling • thalassemias, • megaloblastic anemia • infections • liver disease • lead poisoning • unstable hemoglobins • pyrimidine-5- nucleotidase deficiency
- 15. Hypochromasia • iron deficiency anemia • sideroblastic anemia • thalassemias
- 16. Dimorphic Red Cell Population • two distinct populations • development or resolution of IDA or anemia of chronic deficiency • post blood transfusion • acquired sideroblastic anemia
- 17. Spherocytes • hereditary spherocytosis • ABO hemolytic disease of the newborn • autoimmune hemolytic anemia • microspherocytes • sphero-echinocytes
- 18. Elliptocytes and Ovalocytes • hereditary elliptocytosis • hereditary pyropoikilocytosis • southeast asian ovalocytosis
- 19. Schistocytes • RBC fragments • thalassemias • CDA • Megaloblastic anemia • microangiopathic hemolytic anemia • severe burns • hemolytic uremic syndrome(HUS) • thrombotic thrombocytopenic purpura(TTP)
- 20. Acanthocytes • Abnormal phospholipid metabolism • McLeod phenotype • Splenectomy • hyposplenism • Severe Liver disease
- 21. Crenated RBC/Echinocytes • healthy subjects • storage artefact • uremia • cardiopulmonary bypass • premature infants
- 22. Target Cells • iron deficiency anemia • thalassemia • sickle cell anemia • Hemoglobinopathies • Chronic liver disease • splenectomy • Hereditary hypobetalipoproteine mia
- 23. Stomatocytes • Liver disease • alcoholics • MDS
- 24. Sickle Cells • Sickling: blood subjected to anoxia • Sickles and boat shaped forms • Target cells – often a feature
- 27. Polychromasia • Shades of bluish grey • Reticulocytes • Increased erythropoiesis • Absence of polychromasia -inadequate bone marrow response Aplastic anemia Pure red cell aplasia
- 28. Nucleated RBCs • More common in children • Severe anemia • Hemolytic disease of newborn • Leucoerythroblastic anemia:carcinomatoses and primary myelofibrosis • Post splenectomy • Extramedullary erythropoiesis • Sickle cell anemia • Septicemia • Cyanotic heart failure
- 29. Erythrocyte Inclusions: Howell Jolly Bodies • Nuclear remnants • Small round, stain purple • Post splenectomy • Splenic atrophy
- 30. Erythrocyte inclusions: Pappenheimer bodies • Small, peripherally sited basophilic/ almost black • Smaller than howell-jolly inclusions • Composed of hemosiderin • Related to Sideroblastic erythropoiesis and hyposplenism • Confirmed by perls’ stain • Correspond to siderotic granules of siderocytes
- 35. Toxic granulation and Cytoplasmic Vacuolation • Bacterial infection • Other causes of inflammation • Administration of Granulocyte colony stimulating factor
- 36. • Poorly staining (hypogranular) • Agranular neutrophils • Myelodysplastic syndromes • Some forms of myeloid leukemia
- 37. Chediak Higashi syndrome: • Abnormal granules • Giant but scanty azurophilic granules • Functional defect • Susceptibility to severe infection
- 38. Alder Reilly Anomaly: • Nucleus is obscured by cytoplasmic granules • Neutrophils function normally
- 39. Pelger-Huet Cells • Benign inherited condition • Pseudo pelger huet cells: MDS, AML with dysplastic maturation, chronic myeloid leukemia
- 40. Hypersegmented Nuclei • Megaloblastic anemia • Uremia • Iron deficiency anemia • Cytotoxic treatment – methotrexate • Hydroxycarbamide
- 41. Left Shift
- 42. Basophilia • Rarest (<1%) • Myeloproliferative neoplasms • CML: >10% impending accelerated phase/blast crisis
- 43. Eosinophilia • Eosinopenia: prolonged steroid administration • Eosinophilia: - Allergic conditions, - parasitic infections, - reactive eosinophilias ( Lymphomas, ALL) - eosinophilic leukemia, - idiopathic hypereosinophilic syndrome, - CML, - AML
- 44. Monocytes • Chronic infections and inflammatory conditions like TB, Crohn’s disease • Atypical CML, CMML • Acute leukemia with monocytic component
- 45. Lymphocytes • Transformed lymphocytes: viral and bacterial lymphocytes • Immunoblasts or turk cells
- 50. Large/Giant platelets Large Platelets: • Increased platelet production • Hyposplenism • Severe immune thrombocytopenia
- 51. Thrombocytosis • Acute inflammatory stress • Bleeding • Critically ill patient • Hyposplenism • Myeloproliferative neoplasm
- 52. Grey platelet syndrome: • Hypogranular platelets
- 53. Platelet satellitism • antiplatelet autoantibodies • Apparently healthy individuals
- 54. Hemoparasites
- 57. Summary • Simple • morphology • Basic and foundational • Further direction • Patient management
- 58. References • Dacie and Lewis practical hematology – 11th edition • Wintrobe’s clinical hematology – 13th edition
- 59. Thank you