Peripheral blood smear: Difference between revisions

Jump to navigation Jump to search
← Older editNewer edit →
VisualWikitext
Mikael Häggström (talk | contribs)
Administrators, Editors, Image-reviewer, csmoderator, Interface administrators, Administrators, Upload Wizard campaign editors
7,132 edits
Mikael Häggström (talk | contribs)
Administrators, Editors, Image-reviewer, csmoderator, Interface administrators, Administrators, Upload Wizard campaign editors
7,132 edits
Line 10: Line 10:


==Red blood cells==
==Red blood cells==
{|class=wikitable align=right
===Automated values===
! RDW in adults<ref name=MrLabTest>{{cite web|url=https://www.mrlabtest.com/high-RDW-blood.htm|website=MrLabTest|title=High RDW level in the blood}} Last update: 12/01/2021</ref> !! Terminology<ref name=MrLabTest/>
When available, automatic quantification of mean corpuscular volume (MCV) and red blood cell (RBC) 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. If mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) are normal, but you still see multiple RBCs with central pallor greater than 50% of the diameter, you can report it as ''"Increased central pallor"'', and you may add ''"indicating iron deficiency"'' if it is compatible with the clinical history.
|-
| 14.5% - 18% || Mild anisocytosis
|-
| 18% - 26% || Moderate anisocytosis
|-
| > 26% || Severe anisocytosis
|}


Peripheral blood findings are grades as follows:<ref>{{cite web|url=http://www.hkimls.org/qapeduhsm-rbc-mor.htm|title=Hong Kong Medical Technology Association - Quality Assurance Programme - Haematology and Serology, Prepared by HKMTAQAP Haematology & Serology Panel on November 2002.}}</ref>
Automated values can be graded as follows:<ref name=HongKong>Unless otherwise specified in table, reference is:<br>- {{cite web|url=http://www.hkimls.org/qapeduhsm-rbc-mor.htm|title=Hong Kong Medical Technology Association - Quality Assurance Programme - Haematology and Serology, Prepared by HKMTAQAP Haematology & Serology Panel on November 2002.}}</ref>
{|class=wikitable
{|class=wikitable
! Grade
! +
! ++
! +++
|-
|-
! Interpretation
! Interpretation
! Mild/rare/occasional
! Mild
! Moderate
! Moderate
! Marked/Numerous
! Marked
|-
|-
|  Microcytosis||MCV : 70 - 79||MCV : 60 - 69||MCV <60
|  Microcytosis ||MCV : 70 - 79||MCV : 60 - 69||MCV <60
|-
|-
|  Macrocytosis||MCV : 100 - 115||MCV : 115 - 125||MCV >125
|  Macrocytosis ||MCV : 100 - 115||MCV : 115 - 125||MCV >125
|-
|-
|  Hypochromasia||MCH : 23 - 26||MCH : 21 - 23||MCH <20
|  Hypochromasia||MCH : 23 - 26||MCH : 21 - 23||MCH <20
|-
|-
|  Anisocytosis||RDW: 16-18||RDW : 18-22||RDW>22
|  Anisocytosis||RDW: 14.5<ref name=MrLabTest>{{cite web|url=https://www.mrlabtest.com/high-RDW-blood.htm|website=MrLabTest|title=High RDW level in the blood}} Last update: 12/01/2021</ref> !! Terminology<ref name=MrLabTest/>  or 16<ref name=HongKong/> - 18||RDW : 18 - 22<ref name=HongKong/> or 26<ref name=MrLabTest/> ||RDW > 22<ref name=HongKong/> or 26<ref name=MrLabTest/>
|-
|-
| Polychromasia||3 - 5%||5 - 25%||>25%
|}
 
===Morphologic findings===
Look for poikilocytosis (red blood cells of abnormal shapes):
[[File:Micrograph of an echinocyte on a peripheral blood smear.jpg|thumb|210px|'''Echinocytes''' ("burr cells"), are distinguished from acanthocytes by having more equally distributed and rounded projections. They are usually [[Artifacts|artifactual]], not needing reporting. However, they may also be caused by renal insufficiency, so if this is present, a report may include "Occasional/Multiple echinocytes, consistent with renal insufficiency".]]
<gallery mode=packed heights=150>
File:Human blood film with acanthocytes 02.jpg|'''Acanthocytes''' ("spur cells")
File:Micrograph of an elliptocyte on a peripheral blood smear 02.jpg|thumb|'''Elliptocytes'''
</gallery>
These are counted as a percentage of visible red blood cells:<ref name=HongKong/>
{|class=wikitable
|-
|-
| Spherocytes||1 - 5%||5 - 25%||>25%
! Interpretation
! Rare/Occasional
! Moderate amount of
! Many/Abundant
|-
| Polychromasia||3 - 5%||5 - 25%||>25%
|-
| Spherocytes||1 - 5%||5 - 25%||>25%
|-
|-
| Schistocytes||up to 2%||2 - 25%||>25%
| Schistocytes||up to 2%||2 - 25%||>25%
|-
|-
| Target cells (codocytes)||up to 3%||3 - 25%||>25%
| Target cells (codocytes)||up to 3%||3 - 25%||>25%
|-
|-
| Tear drop cells||up to 2%||2 - 25%||>25%
| Tear drop cells||up to 2%||2 - 25%||>25%
|-
|-
| Burr cells (echinocytes)||1 - 3%||3 - 10%||>10%
| Burr cells (echinocytes)||1 - 3%||3 - 10%||>10%
|-
|-
| Sickle cells (drepanocytes)||3 - 5%||5 - 25%||>25%
| Sickle cells (drepanocytes)||3 - 5%||5 - 25%||>25%
|-
|-
| Elliptocytes||1 - 5%||5 - 25%||>25%
| Elliptocytes||1 - 5%||5 - 25%||>25%
|-
|-
| Basophilic stipplings||up to 2%||2 - 25%||>25%
| Basophilic stipplings||up to 2%||2 - 25%||>25%
|-
|-
| Howell Jolly bodies||up to 1%||2 - 3 %||>3%
| Howell Jolly bodies||up to 1%||2 - 3 %||>3%
|-
|-
|}
|}
When available, automatic quantification of mean corpuscular volume (MCV) and red blood cell (RBC) 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. If mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) are normal, but you still see multiple RBCs with central pallor greater than 50% of the diameter, you can report it as ''"Increased central pallor"'', and you may add ''"indicating iron deficiency"'' if it is compatible with the clinical history.
Look for poikilocytosis (red blood cells of abnormal shapes):
[[File:Micrograph of an echinocyte on a peripheral blood smear.jpg|thumb|210px|'''Echinocytes''' ("burr cells"), are distinguished from acanthocytes by having more equally distributed and rounded projections. They are usually [[Artifacts|artifactual]], not needing reporting. However, they may also be caused by renal insufficiency, so if this is present, a report may include "Occasional/Multiple echinocytes, consistent with renal insufficiency".]]
<gallery mode=packed heights=150>
File:Human blood film with acanthocytes 02.jpg|'''Acanthocytes''' ("spur cells")
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=150>
<gallery mode=packed heights=150>
Retrieved from "https://patholines.org/Peripheral_blood_smear"