Peripheral blood smear (PBS)

Anemia

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Qualitative test used to detect a wide variety of hematologic disorders

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Peripheral Blood Smear (PBS) - Comprehensive Medical Test Guide

Why is it done?
- Microscopic examination of blood cells spread on a glass slide to visualize cellular morphology, size, shape, and abnormalities
- Detection of abnormal red blood cells (RBCs), white blood cells (WBCs), and platelets for diagnosis of blood disorders
- Diagnosis of anemia, leukemia, infections, hemolytic disorders, and parasitic infestations
- Follow-up investigation when complete blood count (CBC) results show abnormalities
- Evaluation of patients with unexplained fever, fatigue, bleeding disorders, or recurrent infections
- Monitoring treatment response in patients with known hematologic malignancies or blood disorders
- Identification of blood parasites such as malaria organisms, babesia, or trypanosomes
Normal Range
- Red Blood Cells (RBCs): Normocytic (7-8 micrometers), normochromic with biconcave disc shape, evenly distributed, no abnormal morphology
- White Blood Cells (WBCs): Neutrophils 50-70%, Lymphocytes 20-40%, Monocytes 2-8%, Eosinophils 1-4%, Basophils 0-1%
- Platelets: Adequate number present (150,000-400,000/µL), normal size and morphology, round to oval shape
- Normal Interpretation: All blood cells appear normal in morphology, size, and distribution with no abnormal cells, parasites, or inclusions detected
Interpretation
- RBC Abnormalities:
  - Microcytic RBCs: Suggest iron deficiency anemia, thalassemia, or chronic disease
  - Macrocytic RBCs: Indicate vitamin B12 or folate deficiency, alcoholism, or myelodysplastic syndrome
  - Hypochromic RBCs: Pale RBCs suggesting low hemoglobin content from iron deficiency or hemoglobinopathy
  - Target Cells: Associated with thalassemia, liver disease, or iron deficiency
  - Schistocytes: Fragmented RBCs indicating hemolytic anemia, thrombotic thrombocytopenic purpura (TTP), or DIC
  - Spherocytes: Smooth, dense, small RBCs suggesting hereditary spherocytosis or autoimmune hemolytic anemia
  - Sickle Cells: Crescent-shaped RBCs in sickle cell disease
- WBC Abnormalities:
  - Left Shift (Increased Immature Cells): Bands and neutrophil precursors present, indicating acute infection, leukemia, or stress response
  - Atypical Lymphocytes: Larger cells with more cytoplasm seen in viral infections (infectious mononucleosis, CMV)
  - Blast Cells: Immature myeloid or lymphoid precursors indicating acute leukemia
  - Toxic Granulation: Abnormal granules in neutrophils indicating severe infection or toxic conditions
- Platelet Abnormalities:
  - Thrombocytopenia: Decreased number of platelets (<150,000/µL) from immune-mediated destruction, bone marrow failure, or consumption
  - Thrombocytosis: Elevated platelet count (>400,000/µL) from myeloproliferative disorders, iron deficiency, or infection
  - Giant Platelets: Abnormally large platelets seen in Bernard-Soulier syndrome or myelodysplastic syndrome
- Inclusions and Special Findings:
  - Parasites: Malaria organisms, Babesia, Trypanosoma, or microfilariae indicate parasitic infection
  - Polychromasia: Bluish-tinged RBCs indicating reticulocytosis and increased RBC production
  - Auer Rods: Rod-shaped inclusions in blast cells diagnostic of acute myeloid leukemia
  - Döhle Bodies: Light blue-stained inclusions in neutrophils seen in infection or May-Hegglin anomaly
Associated Organs
- Primary Organ Systems:
  - Hematopoietic System: Bone marrow production of blood cells, peripheral blood circulation
- Common Conditions Detected:
  - Hematologic Malignancies: Acute and chronic leukemias, lymphomas (via circulating cells)
  - Anemias: Iron deficiency, vitamin B12/folate deficiency, hemolytic anemia, sickle cell disease, thalassemia
  - Infections: Bacterial, viral, parasitic infections; sepsis; infectious mononucleosis
  - Bleeding Disorders: Thrombocytopenia, thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS)
  - Autoimmune Disorders: Autoimmune hemolytic anemia, immune thrombocytopenia (ITP)
  - Liver and Kidney Disease: Target cells in liver disease, schistocytes in kidney disease
- Associated Complications from Abnormalities:
  - Excessive bleeding or bruising from low platelet counts
  - Fatigue, dyspnea, and organ hypoperfusion from severe anemia
  - Recurrent infections from neutropenia or abnormal WBCs
  - Hemolytic crisis in sickle cell disease or hereditary spherocytosis
  - Thrombotic events in TTP or disseminated intravascular coagulation (DIC)
Follow-up Tests
- Tests Based on PBS Findings:
  - Reticulocyte Count: To assess bone marrow response in anemia
  - Iron Studies (Ferritin, Iron, TIBC): When microcytic anemia is detected
  - Vitamin B12 and Folate Levels: When macrocytic anemia or hypersegmented neutrophils detected
  - Hemoglobin Electrophoresis: When sickle cells or target cells observed
  - Direct Antiglobulin Test (DAT/Coombs): When spherocytes and polychromasia suggest hemolytic anemia
  - Flow Cytometry: When abnormal lymphocytes or blasts are identified
  - Bone Marrow Biopsy/Aspiration: When blasts detected, cytopenias present, or PBS findings suggest malignancy
  - Thick and Thin Malaria Smears: When parasites detected on routine smear, specific parasite identification may require special staining
  - Coagulation Studies (PT, PTT, INR): When schistocytes or significant thrombocytopenia detected
  - Liver Function Tests: When target cells observed to evaluate for hepatic disease
  - LDH and Bilirubin: When hemolysis markers needed to confirm hemolytic anemia
- Monitoring Frequency:
  - Acute leukemia: Weekly or bi-weekly during induction therapy, then monthly during maintenance
  - Chronic leukemia: Monthly to quarterly depending on treatment status
  - Anemia: Every 1-3 months while under treatment or until stable
  - Post-transfusion: Follow-up smear to assess response and rule out complications
Fasting Required?
- Fasting Required: No
- Duration: Not applicable - patient can eat and drink normally
- Medications to Avoid: No medications need to be avoided specifically for PBS. However, inform physician of current medications as some may affect results
- Patient Preparation Requirements:
  - No special preparation needed
  - Patient may remain seated or lie down during venipuncture
  - Relaxation recommended to reduce stress-related leukocytosis
  - Inform phlebotomist of recent illnesses, medications, or unusual symptoms that could affect interpretation
  - Best performed in morning when white blood cell counts are more stable
  - Sample should be collected in EDTA (lavender-top) tube for optimal cell preservation
  - Smear should be prepared within 30 minutes of collection for best morphology

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