Blood smear interpretation

Kamoltip Lertchaisataporn, M.D.

Division of Hematology
Department of Medicine
BLOOD SMEAR INTERPRETATION
Blood smear interpretation
History and physical examination are important and
informative
Smear interpretation skill are helpful in experience
hands
BLOOD SMEAR INTERPRETATION
Blood smear interpretation
Smear interpretation skill
Guideline

Platelet
White cell
Red cell
 platelet

low normal high

6 diseases WBC ET

low normal high

Agranulocytosis Chronic
RBC
leukemia
BLOOD SMEAR INTERPRETATION
pancytopenia with relative
Smear interpretation skill lymphocytosis
Guideline

Platelet blasts
Low platelet number microangipathic hemolytic

Aplastic anemia anemia (MAHA)

Acute leukemia
leukoerythroblastic blood
Myelophthisis atypical lymphocytes
picture
ITP
isolated thrombocytopenia
TTP

Dengue hemorrhagic fever

 BLOOD SMEAR INTERPRETATION
Smear interpretation skill
Guideline

White cells
High chronic leukemia (CML, CLL)
Low agranulocytosis
Normal red cell disorders
multi-stage of myeloid series

monotonous
BLOOD SMEAR INTERPRETATION
Smear interpretation skill
Guideline

Red cells
Iron deficiency anemia

Hemolysis

Thalassemia

Spherocytosis: AIHA and HS

G-6-PD deficiency anemia with hemolysis

Microangiopathic hemolytic anemia

BLOOD SMEAR INTERPRETATION
 55 3
PALE, NO JAUNDICE, NO ORGANOMEGALY

AIHA, cold type

 72 5
Pale, no jaundice, no organomegaly

Megaloblastic anemia
Iron def
22
Pale, mild jaundice, spleen 2 FB

HS
Hb E homozygote
THALASSEMIA DISEASE
TTP
TOXIC GRANULATION

Acute infections
Burn
Drug poisoning
Acute lymphoblastic leukemia (ALL)
ACUTE MYELOID LEUKEMIA (AML)
ACUTE LEUKEMIA
Myeloblast Lymphoblast
Low N/C ratio High N/C ratio
Fine nuclear Clumped nuclear
chromatin chromatin
2-5 nucleolus 0-1 nucleolus

Granules + Auer rod No Auer rod

Blue-gray cytoplasm Blue cytoplasm

ACUTE PROMYELOCYTIC LEUKEMIA (APL)
Acute monocytic leukemia (M5)
CHRONIC LYMPHOCYTIC LEUKEMIA (CLL)
CHRONIC MYELOID LEUKEMIA (CML)
PSEUDO PELGER-HUET ANOMALY :
MDS
 Myelofibrosis
49 YR , NO UNDERLYING DISEASE
FATIGUE 3 MO, NO BLOOD LOSS, NO OTHER SYMPTOM :
PALE, NO JAUNDICE, LIVER 1 FB, SPLEEN 7 FB
PRIMARY MYELOFIBROSIS (PMF)
Clue : Hepatosplenomegaly
Leukoerythroblastic blood picture
BM fibrosis : dry tap
Leukoerythroblastic blood picture : Myelophthisis
THROMBOCYTOPENIA AND ERRORS IN PLT.
COUNT
SPURIOUS PLATELETS
Blood smear tutorial
BLOOD SMEAR TUTORIAL
What is the (most likely) diagnosis?
A. Thalassemia
B. Iron deficiency anemia
C. G-6-PD deficiency anemia
D. ITP
E. Autoimmune hemolytic anemia
BLOOD SMEAR TUTORIAL
What is the (most likely) diagnosis?
A. Thalassemia
B. Iron deficiency anemia
C. G-6-PD deficiency anemia
D. Hereditary spherocytosis
E. Autoimmune hemolytic anemia
BLOOD SMEAR TUTORIAL
What is the name of this cell?
A. Spherocyte
B. Basophilic strippling
C. Target cells
D. Howell Jolly bodies
E. Nucleated red cell
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This cell can be found in which of the following
Condition(s)?
A. Thalassemia
B. G-6-PD deficiency anemia
C. Hereditary spherocytosis
D. asplenia
E. All of the above
BLOOD SMEAR TUTORIAL
What is(are) the abnormality(ies) detected in this slide?
A. thrombocytopenia
B. Burr cells
C. Target cells
D. P.falciparum
E. All of the above
BLOOD SMEAR TUTORIAL
What is the (most likely) diagnosis?
A. Iron deficiency anemia
B. G-6-PD deficiency anemia
C. Hereditary spherocytosis
D. Autoimmune hemolytic anemia
E. Malaria
BLOOD SMEAR TUTORIAL
What is the (most likely) diagnosis?
A. Iron deficiency anemia
B. G-6-PD deficiency anemia
C. Hereditary spherocytosis
D. Homozygous hemoglobin E
E. Malaria
Hemoglobin leakage
cell

eccentrocytes
BLOOD SMEAR TUTORIAL
What is the (most likely) diagnosis?
A. Iron deficiency anemia
B. Hereditary spherocytosis (HS)
C. G-6-PD deficiency anemia
D. Autoimmune hemolytic anemia (AIHA)
E. B and D
BLOOD SMEAR TUTORIAL
What is the (most likely) diagnosis?
A. Active SLE
B. DIC
C. TTP
D. HUS
E. All of the above
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What is the (most likely) diagnosis?
A. Acute promyelocytic leukemia (APL)
B. Chronic myeloid leukemia (CML)
C. Acute lymphoblastic leukemia (ALL)
D. Chronic lymphocytic laeukemia (CLL)
E. Who knows?
What is this finding?
A. Leukoerythroblastic blood picture
B. Acute leukemia
C. Myelophthisis
D. Shift to the left
E. A and C
BLOOD SMEAR TUTORIAL
What is(are) the abnormality(ies) detected in this slide?
A. Elevated plasma cells
B. Autoagglutination
C. Rouleaux formation
D. A and C
E. All of the above
BLOOD SMEAR TUTORIAL
What is(are) the abnormality(ies) detected in this slide?
A. Elevated plasma cells
B. Autoagglutination
C. Rouleaux formation
D. A and C
E. All of the above
BLOOD SMEAR TUTORIAL
What is the (most likely) diagnosis?
A. Acute viral infection
B. Waldenstrom macroglobulinemia
C. Multiple myeloma (MM)
D. Chronic lymphocytic laeukemia (CLL) with secondary AIHA
E. Who knows?
THANK YOU FOR YOUR
ATTENTION