Peripheral blood smear: Difference between revisions
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When available automatic quantification of mean corpuscular volume (MCV) and red blood cell distribution width (RDW), usually as part of CBC panel, generally decides whether you will call the sample "'''normocytic'''" versus "microcytic"/"macrocytic" and/or "anisocytotic", even if it is not clearly visible in the microscope. If automated values are not available, compare RBC sizes to lymphocyte nuclei, which should normally be the same size. | When available automatic quantification of mean corpuscular volume (MCV) and red blood cell distribution width (RDW), usually as part of CBC panel, generally decides whether you will call the sample "'''normocytic'''" versus "microcytic"/"macrocytic" and/or "anisocytotic", even if it is not clearly visible in the microscope. If automated values are not available, compare RBC sizes to lymphocyte nuclei, which should normally be the same size. | ||
'''Schistocytes''' (fragmented parts red blood cells) only needs mentioning if constituting over 1% of red blood cells. | Look for poikilocytosis (red blood cells of abnormal shapes): | ||
<gallery mode=packed heights=200> | |||
File:Human blood film with acanthocytes 02.jpg|'''Acanthocytes''' ("spur cells") | |||
File:Micrograph of an echinocyte on a peripheral blood smear.jpg|'''Echinocytes''' ("burr cells"), distinguished from acanthocytes by having more equally distributed and rounded projections. They do not need mention in the report. | |||
File:Micrograph of an elliptocyte on a peripheral blood smear 02.jpg|thumb|'''Elliptocytes''' | |||
</gallery> | |||
'''Schistocytes''' (fragmented parts red blood cells) only needs mentioning if constituting over 1% of red blood cells or at least 2 per oil immersion field. | |||
<gallery mode=packed heights=200> | |||
File:Micrograph of a red blood cells with an overlying platelet on a peripheral blood smear.jpg|When seeing what appears to a platelet overlying a red blood cells (as pictured), confirm that there is a halo. | |||
File:Blood stages of P. falciparum over 48h.jpg|Otherwise, make sure it is not '''malaria''' (appearance at different intraerythrocytic blood stages is pictured)... | |||
File:Human blood film with babesia.jpg|...or babesia. | |||
</gallery> | |||
===Platelets=== | ===Platelets=== | ||
If CBC is performed, use count to determine whether platelets are "normal in number" or whether there is "thrombocytopenia" or "thrombocytosis". If no CBC, count platelets within a high power oil immersed field, which should normally be 8 to 20. | If CBC is performed, use count to determine whether platelets are "normal in number" or whether there is "thrombocytopenia" or "thrombocytosis". If no CBC, count platelets within a high power oil immersed field, which should normally be 8 to 20. | ||
In '''thrombocytopenia''' from automatic counting, look in particular for clumping of platelets (which can cause a falsely low automatic platelet count). If present, check with the lab if it was sent in EDTA (which may cause artefactual clumping) and ask to have a blood sample sent in sodium citrate instead. | In '''thrombocytopenia''' from automatic counting, look in particular for clumping of platelets (which can cause a falsely low automatic platelet count). If present, check with the lab if it was sent in EDTA (which may cause artefactual clumping) and ask to have a blood sample sent in sodium citrate instead. Also, look for satellitosis (platelets attached around white blood cells). | ||
===White blood cells=== | ===White blood cells=== | ||