Post on 16-Jul-2015
Basic MorphologyKaipol Takpradit,MD
Department of Medicine Bhumibol Adulyadej Hospital
Introduction
Peripheral Blood Smear
Very simple investigation
Provide useful informations
The first to check when CBC show
abnormal
How to make PBS
How to make PBS
Understanding PBS
Morphology of cells result from physical
property of cells
Physic not Magic!!
Principle of PBS
Find proper area
Known relative cell size
Known how cell’s composition stain
Known normal
Romanowsky stain
Acidic + basic = neutral dye staining
(Eosin Y + methylene blue) in methanol
= Wright’s stain
Wright’s stain
Basophilia (methylene blue)
Azurophilia (oxidized methylene blue)
Acidophilia (eosin)
Neutrophilia (mixture of dye)
Wright’s stain
Basic dye bind to acid
Nucleic acid (DNA, RNA)
Protein
Acidic dye bind to base
Cytoplasm
Hemoglobin
RBC
Abnormal RBC
Abnormal RBC
Abnormal RBC
Abnormal RBCHemoglobin leakage cells
Ghost cell
Abnormal RBC
Burr cells
Abnormal RBC
Spur cell
Abnormal RBC
Tear drop cell
Abnormal RBC
Auto-agglutination
Abnormal RBC
Rouleaux formation
Complete blood count
Hematocrit = packed red cell volume
Hemoglobin = concentration of Hb
Platelet count = amount of Plt.
WBC count = show amount of RBC
and differential by flow cytometry
Complete blood count
MCV = volume of RBC (fL)
MCH = Amount of hemoglobin (pg)
MCHC = Hb concentration in each cells
RDW = variety of RBC size
MCVNormal 85 - 95
1 trait 70 + 8.7
2 trait 85 + 5.5
trait 68 + 6.9
Hb E trait 84 + 5.1
Hb EE 73 + 5.7
Hb H disease 67 + 6.7
/E thal 69 + 5.6
thal 55 - 65
Complete blood count
Hct is approximately 3 times of Hb
HbH has Hct higher that expected
MCHC is high in hereditary
spherocytosis
RDW is usually wide in abnormal RBC
formation
Case demonstration
Iron deficiency anemia
Hct 21% Hb 6.9 g/dL
WBC 7,000/mcL
PMN 75%
Plt 500,000/mcL
MVC 67 fL MCH 20
pg MCHC 21 g/dL
RDW 20%
Iron deficiency anemia
Hct 21% Hb 6.9 g/dL
WBC 7,000/mcL
PMN 75%
Plt 500,000/mcL
MVC 67 fL MCH 20
pg MCHC 21 g/dL
RDW 20%
Thalassemia (HbH)
Hct 26% Hb 7 g/dL
WBC 7,000/mcL
PMN 75%
Plt 350,000/mcL
MVC 67 fL MCH 20
pg MCHC 21 g/dL
RDW 20%
Thalassemia (HbH)
Hct 26% Hb 7 g/dL
WBC 7,000/mcL
PMN 75%
Plt 350,000/mcL
MVC 67 fL MCH 20
pg MCHC 21 g/dL
RDW 20%
Thalassemia trait
Hct 36% Hb 12 g/dL
WBC 7,000/mcL
PMN 75%
Plt 350,000/mcL
MVC 78 fL MCH 24
pg MCHC 25 g/dL
RDW 12%
Thalassemia trait
Hct 36% Hb 12 g/dL
WBC 7,000/mcL
PMN 75%
Plt 350,000/mcL
MVC 78 fL MCH 24
pg MCHC 25 g/dL
RDW 12%
Homozygous HbE
Hct 35% Hb 12 g/dL
WBC 7,000/mcL
PMN 75%
Plt 350,000/mcL
MVC 75 fL MCH 24
pg MCHC 25 g/dL
RDW 12%
Homozygous HbE
Hct 35% Hb 12 g/dL
WBC 7,000/mcL
PMN 75%
Plt 350,000/mcL
MVC 75 fL MCH 24
pg MCHC 25 g/dL
RDW 12%
Hereditary spherocytosis
Hct 30% Hb 10 g/dL
WBC 7,000/mcL
PMN 75%
Plt 120,000/mcL
MVC 80 fL MCH 31
pg MCHC 38 g/dL
RDW 15%
Hereditary spherocytosis
Hct 30% Hb 10 g/dL
WBC 7,000/mcL
PMN 75%
Plt 120,000/mcL
MVC 80 fL MCH 31
pg MCHC 38 g/dL
RDW 15%
AIHA
Hct 20% Hb 7 g/dL
WBC 20,000/mcL
PMN 75%
Plt 200,000/mcL
MVC 92 fL MCH 31
pg MCHC 38 g/dL
RDW 22%
AIHA
Hct 20% Hb 7 g/dL
WBC 20,000/mcL
PMN 75%
Plt 200,000/mcL
MVC 92 fL MCH 31
pg MCHC 38 g/dL
RDW 22%
G-6-PD deficiency
Hct 22% Hb 7 g/dL
WBC 20,000/mcL
PMN 75%
Plt 200,000/mcL
MVC 92 fL MCH 31
pg MCHC 38 g/dL
RDW 22%
G-6-PD deficiency
Hct 22% Hb 7 g/dL
WBC 20,000/mcL
PMN 75%
Plt 200,000/mcL
MVC 92 fL MCH 31
pg MCHC 38 g/dL
RDW 22%
ITP
Hct 37% Hb 12 g/dL
WBC 8,000/mcL
PMN 75%
Plt 20,000/mcL
MVC 85 fL MCH 31
pg MCHC 30 g/dL
RDW 12%
ITP
Hct 37% Hb 12 g/dL
WBC 8,000/mcL
PMN 75%
Plt 20,000/mcL
MVC 85 fL MCH 31
pg MCHC 30 g/dL
RDW 12%
TTP
Hct 30% Hb 10 g/dL
WBC 8,000/mcL
PMN 75%
Plt 60,000/mcL
MVC 91 fL MCH 31
pg MCHC 30 g/dL
RDW 18%
TTP
Hct 30% Hb 10 g/dL
WBC 8,000/mcL
PMN 75%
Plt 60,000/mcL
MVC 91 fL MCH 31
pg MCHC 30 g/dL
RDW 18%
CLL
Hct 28% Hb 9 g/dL
WBC 50,000/mcL
Lymph 80%
Plt 190,000/mcL
MVC 81 fL MCH 31
pg MCHC 30 g/dL
RDW 13%
CLL
Hct 28% Hb 9 g/dL
WBC 50,000/mcL
Lymph 80%
Plt 190,000/mcL
MVC 81 fL MCH 31
pg MCHC 30 g/dL
RDW 13%
CMLHct 31% Hb 9 g/dL
WBC 80,000/mcL
PMN 30% myelo
20% meta 10% pro
10%
Plt 590,000/mcL
MVC 81 fL MCH 31
pg MCHC 30 g/dL
RDW 13%
CMLHct 31% Hb 9 g/dL
WBC 80,000/mcL
PMN 30% myelo
20% meta 10% pro
10%
Plt 590,000/mcL
MVC 81 fL MCH 31
pg MCHC 30 g/dL
RDW 13%
Primary myelofibrosis
Hct 28% Hb 9 g/dL
WBC 8,000/mcL
PMN 55%
Plt 80,000/mcL
MVC 92 fL MCH 31
pg MCHC 30 g/dL
RDW 16%
Primary myelofibrosis
Hct 28% Hb 9 g/dL
WBC 8,000/mcL
PMN 55%
Plt 80,000/mcL
MVC 92 fL MCH 31
pg MCHC 30 g/dL
RDW 16%
AML
Hct 22% Hb 7 g/dL
WBC 40,000/mcL
Blast 90%
Plt 30,000/mcL
MVC 92 fL MCH 31
pg MCHC 30 g/dL
RDW 14%
AML
Hct 22% Hb 7 g/dL
WBC 40,000/mcL
Blast 90%
Plt 30,000/mcL
MVC 92 fL MCH 31
pg MCHC 30 g/dL
RDW 14%
Lymphoma leukemic phase
Hct 30% Hb 10 g/dL
WBC 4,000/mcL
PMN 80%
Plt 120,000/mcL
MVC 92 fL MCH 31
pg MCHC 30 g/dL
RDW 14%
Lymphoma leukemic phase
Hct 30% Hb 10 g/dL
WBC 4,000/mcL
PMN 80%
Plt 120,000/mcL
MVC 92 fL MCH 31
pg MCHC 30 g/dL
RDW 14%
FIN