BLOOD FILMS-
Normal Blood Film-
High power view of a normal peripheral blood smear. Several
platelets (black arrows) and a normal lymphocyte (blue arrow) can
also be seen. The red cells are of relatively uniform size and
shape. The diameter of the normal red cell should approximate that
of the nucleus of the small lymphocyte; central pallor (red arrow)
should equal one-third of its diameter.
Beta-thalassaemia trait-
Peripheral smear from a patient with beta thalassemia trait. The
field shows numerous hypochromic and microcytic red cells (thin
arrows), some of which are also target cells (blue arrows).
Courtesy of Stanley Schrier, MD
Sickle Cell anaemia-
Peripheral smear from a patient with sickle cell anemia shows
multiple spindly sickle cells (blue arrows), a nucleated red blood
cell in the upper left, and a Howell-Jolly body (black arrow),
which is a nuclear fragment normally removed by the spleen. Target
cells are also present (red arrow). This patient has functional
asplenia because of repeated splenic infarctions.
Howell-Jolly bodies-
This peripheral blood smear shows Howell-Jolly bodies in two red
cells (black arrows), nuclear remnants that are normally removed by
the spleen. Thus, they are seen in patients who have undergone
splenectomy (as in this case) or have functional asplenia (eg,
sickle disease disease). Target cells are also seen (blue arrows),
another consequence of splenectomy.
Hemolytic Anemias, Characterized by Different Types of
Poikilocytes-
The blood smear shows hereditary elliptocytosis, with numerous
elliptocytes and smaller numbers of ovalocytes
Shows hereditary pyropoikilocytosis; there is striking
poikilocytosis, with elliptocytes, ovalocytes, and fragments.
Shows microangiopathic hemolytic anemia resulting from
cyclosporine therapy,
with numerous red-cell fragments. All specimens were stained
with MayGrnwaldGiemsa stain.
Figure 2. Red-Cell Changes in Various Types of Hemolytic
Anemia.
The blood smear in Panel A depicts acute hemolysis in
glucose-6-phosphate dehydrogenase (G6PD) deficiency, with the
presence of a bite cell, or keratocyte (arrow).
Figure 2. Red-Cell Changes in Various Types of Hemolytic
Anemia.
Panel B shows acute hemolysis in G6PD deficiency, with two
blister cells (arrows), as well as polychromatic macrocytes and
irregularly contracted cells (arrowheads).
Figure 2. Red-Cell Changes in Various Types of Hemolytic
Anemia.
In Panel C, hereditary spherocytosis is characterized by
numerous spherocytes (hyperchromatic cells with a regular
outline).
Figure 2. Red-Cell Changes in Various Types of Hemolytic
Anemia.
Panel D shows paroxysmal cold hemoglobinuria, with
erythrophagocytosis; the arrow points to a red cell that has been
phagocytosed by a neutrophil. All specimens were stained with
MayGrnwaldGiemsa stain.
Figure 3. Red-Cell Changes in Various Types of Macrocytic
Anemia.
Pernicious anemia is shown in the blood smear in Panel A, with
anisocytosis, macrocytosis, and a hypersegmented neutrophil.
Figure 5. Blood-Smear Features Associated with Thrombocytopenia
and Errors in the Platelet Count. Panel A shows large clumps of
platelets that led to a factitiously low platelet count. Panel B
demonstrates platelet satellitism.
Figure 6. Miscellaneous Conditions in Which the Blood Smear Can
Be Diagnostically Important.Panel A shows Burkitts lymphoma, with
three basophilic vacuolated lymphoma cells
Figure 6. Miscellaneous Conditions in Which the Blood Smear Can
Be Diagnostically Important. Panel B, with two characteristic
bilobed leukemic promyelocytes.
Figure 6. Miscellaneous Conditions in Which the Blood Smear Can
Be Diagnostically Important. Panel D shows target cells (short
arrow), acanthocytes (long arrow), and a HowellJolly body
(arrowhead) all features of hyposplenism in a blood smear
from a patient with iron-deficiency anemia and splenic atrophy
as features of celiac disease. All specimens were stained with
MayGrnwaldGiemsa stain
Source- NEJM Blood Films. August 4, 2005.