BLOOD FILM EXAMINATION

Dr Nornazirah Azizan
FMHS, UMS
 RED CELL SERIES
1.Anisocytosis-variation in size of red cells
Microcytes (MCV <76 fL) eg. IDA, Thal, sideroblastic
anaemia
Macrocytes (MCV>100 fL) eg. B12 & folate deficieny,
liver d/s, hypothyroid
2.Poikilocytosis- variation in shape of red cells eg.
a. Target cells: Thalassemia, liver d/s, post splenectomy
b. Spherocytes: Autoimmune haemolytic anaemia (AIHA)
c. Sickle cells: Hb S
d. Red cell fragments: Disseminated intravascular
coagulation (DIC)
e. Bite cells: G6PD deficiency

e
d
c a
b
3. Staining
• hypocromia (RBC central pallor which occupies more
than the normal 1/3 of the red cell diameter) eg. IDA,
thalassemia, sideroblastic anaemia
• Polychromasia (Red cells stain shades of blue-gray as a
consequence of uptake of both eosin (Hb) and basic
dyes (residual ribosomal RNA). Often slightly larger than
normal RBC and they are reticulocytes. eg. Haemolytic
anaemia, thalassemia
Hpochromia (ring cells) Polychromasia

4.Immature red cells (Nucleated RBC):Normally seen in

BM only. Can be seen in peripheral blood in cases of severe
haemolysis, thalassemia, bone marrow infiltration by a
tumour
NRBC
NRBC

Lymphocyte
5. Red cell Inclusion bodies
Howell-Jolly bodies:
• DNA nuclear remnants, single deep purple of varying
size; eg. post-splenectomy, megalobalstic anaemia,
haemolytic anaemia.
Basophilic stippling (punctate basophilia)
• Aggregates of Ribrosomes seen as multiple blue black
inclusions evenly distributed eg. lead poisoning,
thalassemia
Heinz bodies
• Better seen by supravital staining eg.methyl violet or
brilliant green
• Single round inclusion of denatured Hb at cell margin
eg. post-splenectomy, G6PD deficiency
Howell-Jolly bodies Heinz bodies

Basophilic stippling
6. Rouleaux stack of rbc due to the loss of normal
electrostatic charge that repels red cells due to coating
with abnormal paraproteins. Eg. Multiple myeloma, B
lymphoma

7. Haemoparasites eg. mp

Pl falciparum (ring and gametocytes)

 White cell series
• Total count: 4000-11,000/cumm
• Differential counts:
Reference range
Neutrophils (40-75%)
Lymphocytes (20-50%)
Monocytes (2-10%)
Eosinophils (1-8%)
Basophils (0- 1%)
 Neutrophil & lymphocyte: RBC is 2/3 Monocyte: larger than a lymphocyte
size of a lymphocyte. and has a folded nucleus.

Eosinophil: reddish coarse granules in Basophil: coarse granules in

cytoplasm cytoplasm.
 Platelets
• Total count:150,000- 450,000cumm
• Abnormal forms: small platelets (Wiskott Aldrich
syndrome ), giant platelets (Bernard Soulier d/s)

Normal platelet and two giant platelets

Normal data of RBC in a automated
haematology analyzer
 Practical slides
• Hypochromic microcytic anaemia probably due to
Iron deficiency
• Haemolytic anaemia probably thalassemia
• Acute leukemia
Hypochromic microcytic anaemia probably
due to Iron deficiency
RBC series
• Anisocytosis: microcytes
• Poikilocytosis: oval cells, pencil shaped, target cells
• Hypochromia: ring cells
• Immature RBC (nucleated RBCs): not seen
• No haemoparasites or red cell inclusions
• Normal arrangement of RBC
WBC series
• Normal total and differential counts
Platelets: Normal count .No abnormal platelets
Hypochrmic ring cells
Pencil shaped cells
Haemolytic anaemia probably thalassemia
• RBC series
• Anisocytosis: microcytes, * polychromatic
macrocytes
• Poikilocytosis: *target cells
• Polychromatic cells: reticulocytes
• Immature RBC (nucleated RBCs): *numerous seen
• No haemoparasites or red cell inclusions
• Normal arrangement of RBC
WBC series: Normal total and differential counts
Platelets: Normal count. No abnormal platelets
NRBC
Polychromasia
(reticulocytes)

NRBC
 ACUTE LEUKEMIA
WBC series
• Total white blood cell count: very much increased
Differential count
• Blast cells constitute 92% of total white cells
• Lymphocytes 8%
• Smear cells +
• Morphology of blasts: large round cells with single round
nuclei containing 1-2 nucleoli
• RBC series: Normocytic normochromic anaemia
• Platelets: markedly reduced

Smear cell

Blast
Thank you.