Uses of PBS

Red cell DLC Platelet Hemoparasite

How to make a PBS

Manual method Automated method Thick film Thin film

Ideal PBS
3 Parts head, body, tail 3 cm long Labeled Fixing before staining

Stains
Romanowsky stainJennes Giemsas Leishmans Wrights Combine

Red cell
Site of examination Shape Size Central pallor

Rouleaux
Alignment of red cells Due to plasma fibrinogen & globulin Seen normally in para-proteinemias

RBCs

variations

Colour normochromic hypochromic hyperchromic

Size(anisocytosis) normocyte macrocyte microcyte

Shape(poikilocytosis)

Hypochromic
Abnormal thinness Decreased Hb Size Central pallor MCV/MCHC

Hypochromic/Normochromic

Iron def A,Thalassemia, Sideroblastic A

Hyperchromic
Thick & deeply stain Central pallor

Megaloblast

Spherocyte

Hyperchromic/Normochromic

Polychromatophilia
Blue gray tint due to residual RNA with Romnowsky with Brilliant cresyl blue Seen in: Hemolysis Acute blood loss

Size(anisocytosis)

Microcyte
Volume MCV<80 fl Associated hypochromasia Seen in:

Macrocyte
Large MCV>100fl Seen in:

Shapes(poikilocytosis)

Elliptocyte

Normal person (<10%), Herd.Elliptocytosis, Iron def. A, Megaloblastic A, Sickle cell A

Spherocyte
Spherical Size (not microcytic) Deeply stained Central pallor Hyperchromic

Target cells
Thinner, less Hb, large volume Redistributed Hb Seen in Thalassemia Sickle cell anemia Iron def anemia Post spleenectomy

Schitocyte
Cell fragments Irregular Signifies hemolysis Seen inMegaloblastic A. Severe burns Microangiopathic A.

Burr cell
Irregularly contracted cells Prominent,numerous& regularly placed spicules Seen in: Uremia Pyruvate kinase def. Drug induced hemolytic A

Acanthocyte
Regularly large spiculated cells Spicules are bulbous & rounded Seen in: Abetalipoproteinemia Liver disease

Sickle cell

Leptocyte
Unusually thin red cells Stained as rings Central area Seen in: Iron def A Thalassemia

Stomatocyte
Slit like central core Cup shaped in wet preparation Seen inLiver D Alcoholism Myelodysplastic Syn

Smudge cell
Damaged cell No cytoplasm

Inclusions

Basophilic Stippling
Numerous fine to coarse,irregular basophilic granules Signifies disturbed erythropoisis Seen in: Infection Liver disease Thalassemia Lead & heavy metal P.

Pappenheimer Bodies
Haemosiderin granules Few, peripherally sited,basophilic Signifies iron overload & hypospleenism

Siderotic granules
Same as pappenheimer bodies but are Perls stained Positive Perls reaction-Blue

Howell Jolly Bodies

Smooth, round Remnants of nuclear chromatin Indicative of abnormal erythropoisis Seen in: Megaloblastic anemia Hemolytic anemia Post spleenectomy

Cabot ring
Ring, loop or figure of eight No internal structure Microtubules remnant Signifies abnormal erythropoisis Seen in: Pernecious A Lead poisoning

 In vitro- organic & inorganic oxidizing agents In vivo late sign of oxidative damage Represents end product of Hb degradation

Inclusions

Basophilic stippling

Howell-Jolly bodies

Cabot's ring bodies

Heinz's bodies

MALARIAL PARASITE

Nucleated RBC
Fetal & young child Severe anemia Post spleenectomy Sickle cell anemia Leukemia Myelofibrosis Septicemia

Nucleated RBC

WBCs

Neutrophil
50-70% 12um Pink to orange cytoplasm Deeply stained nucleus, lobulated Fine pink to purple granules Coarse chromatin

Lobulation

Lobes <3% bands

10-30% two lobes

40-50% three lobes 10-20% four lobes <5% five or more

Neutrophil
Abnormalities

Quantitative Nuetrophilia Neutropenia

Qualitative toxic granules dohle bodies May Heggelin anomaly......

Segmentation right shift left shift

Neutrophilia
>70% Acute bacterial infection Acute Inflammation Myeloproliferative D

Neutropenia
Infection-typhoid paratyphoid RMSF Radiation Chemical Steroids Anemias

Toxic granules
More in number Blue to purple Deeply stained Seen in: Infection Inflammation Myelofibrosis Aplastic anemia

Dohle body
Small, oval, pale blue At periphery Remnants of ribosome & ER Seen in: Infection Aplastic anemia Burns

May- Hegglin Anomaly

AD Resembles Dohle bodies Larger, more prominent, pale blue Also seen in other WBCs (except Lym)

Alder Reilly anomaly

Resemble toxic granules Dense, large, deeply stained granules Obscures the nucleus Mucopolysaccharidosis

Pelger-Heut Anomaly
AD Failure of segmentation Nuclei are band shaped Functionally normal

Giant & scanty granules

Chediak Higachi syndrome Functionally abnormal Susceptible to infection

Right shift:
Megaloblastic A, Uremia, Iron def A

Left shift: Sepsis, leukemia, leukaemoid reaction

Band form

Promyelocyte

Metamyelocyte

Myeloblast

Eosinophil
13um 1-6% Large,round,oval, eosinophilic granules 2 connected lobes of nucleus

Eosinophilia
Allergic condition Skin disorders Parasitic infection Infectious Diseases Hyper eosinophilic S Post spleenectomy

Basophil
0-1% (rarest) Blue cytoplasm Large, purple to black granules Nucleus

Basophilia
Allergic reaction CML Myeloid metaplasia Radiation Polycythemia vera

Basopenia
Steroids Acute infections

Monocyte
Largest leukocyte (15-18 um) 3-8% Bluish, abundant cytoplasm, ground glass appearance Small, fine, red to purple granules Large, curved, horse shoe shaped nucleus Condensed chromatin

Monocytosis
Recovery stage Chronic infection CML AML TB SABE

Monocytopenia
Hairy cell leukemia Steroids

Lymphocyte
25-45% Mononuclear cells Small (6-10um) Rim of pale blue cytoplasm Scanty azurophilic granules Single, uniform, homogenous nucleus Condense chromatin Large(12-15um) 10% only

Variations in lymphocyte

Plasma cell
Eccentric nuclei Clumped chromatin arranged like wheel pattern Abundant cytoplasm Vacuoles Peri-nuclear halo

REACIVE LYMPHOCYE

Large nuclei, open chromatin, Abundant & irregular cytoplasm

Lymphoblast
Large 15-25um High N:C ratio Centrally placed nucleus Coarse chromatin Scanty cytoplasm Seen in ALL

Lymphocytosis
IM Infective hepatitis Infection radiation

Lymphopenia
AIDS Renal failure

Platelet
1-3um Irregular in shape Fine red granules Can be counted by x average no of platelet per OIL field by 20000

 Thrombocytosis
Acute inflammation Bleeding Myeloproliferative D

Thrombocytopenia
ITP TTP HUS HELLP syndrome Drugs(Thiazides) MDS

Morphological changes
Bernard Soulier syndrome- giant platelets. Gray platelet syndrome- lack granules, ghost like May Hagglin anomaly- thrombocytopenia

Thank you