Pheripheral Blood Smear

Anemia

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Qualitative test used to detect a wide variety of hematologic disorders

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Peripheral Blood Smear - Comprehensive Medical Test Guide

Why is it done?
- A peripheral blood smear is a microscopic examination of blood cells spread on a glass slide to evaluate their morphology, number, and types.
- Primary indications include: investigating abnormal complete blood count (CBC) results, diagnosing blood disorders (anemia, leukemia, thrombocytopenia), detecting parasites or abnormal hemoglobin, and monitoring treatment of hematologic diseases.
- Performed when patients present with symptoms such as unexplained fatigue, fever, bleeding or bruising tendencies, pallor, or when initial CBC screening shows abnormalities.
- Used as a confirmatory test to evaluate red blood cell morphology, white blood cell differentials, and platelet abnormalities identified by automated hematology analyzers.
- Timing: typically ordered immediately when CBC results are abnormal or when clinical suspicion for blood disorders exists, with results available within 24-48 hours.
Normal Range
- Normal peripheral blood smear findings include: Red Blood Cells (RBCs) - normocytic (7-8 micrometers), normochromic (normal hemoglobin staining), biconcave disc shape, regular size and color distribution.
- White Blood Cells (WBCs) distribution - Neutrophils: 50-70%, Lymphocytes: 20-40%, Monocytes: 2-8%, Eosinophils: 1-4%, Basophils: 0-1%.
- Platelets - 150,000-400,000 cells/microL (150-400 × 10⁹/L), appearing as small, discrete fragments distributed throughout the slide.
- No abnormal cells, parasites, or inclusions visible. Red blood cell distribution is uniform without clumping or unusual formation patterns.
- Normal results indicate healthy blood cell populations and morphology with no evidence of infection, malignancy, or hematologic disorder.
Interpretation
- Microcytic Red Cells (RBCs smaller than normal) - indicates iron deficiency anemia, thalassemia, or chronic disease. Hypochromic appearance suggests low hemoglobin content.
- Macrocytic Red Cells (RBCs larger than normal) - suggests vitamin B12 or folate deficiency, liver disease, or hemolytic anemia. May indicate immature RBCs (reticulocytes).
- Polychromasia - presence of blue-staining immature RBCs indicates increased RBC production (reticulocytosis), seen in hemolytic anemia or response to blood loss.
- Schistocytes (fragmented RBCs) - indicates microangiopathic hemolytic anemia, thrombotic thrombocytopenic purpura (TTP), or disseminated intravascular coagulation (DIC).
- Spherocytes (dense, small RBCs) - suggests hereditary spherocytosis, autoimmune hemolytic anemia, or thermal burn injury.
- Abnormal WBC differential - elevated neutrophils may indicate infection or leukemia; elevated lymphocytes suggest viral infection or lymphoproliferative disorder; abnormal morphology may indicate immature/blast cells.
- Thrombocytopenia (low platelets <150,000/µL) - indicates bone marrow failure, immune destruction, or increased consumption; elevated platelets (>400,000/µL) suggests reactive thrombocytosis or myeloproliferative disorder.
- Parasites - presence indicates parasitic infection (malaria, babesiosis, etc.). Inclusions or abnormal structures may suggest specific infections or inherited disorders.
- Factors affecting interpretation: staining quality, slide preparation, temperature exposure, and time delay between collection and examination can influence results and morphology assessment.
Associated Organs
- Primary organ system - Hematopoietic (bone marrow) and circulatory systems. Bone marrow produces all blood cell types; abnormal findings reflect marrow dysfunction or systemic disease.
- Spleen - abnormal findings may indicate splenic enlargement, hemolysis, or sequestration disorders affecting RBC and platelet survival.
- Liver - abnormal morphology may indicate liver disease, cirrhosis affecting RBC and platelet production, or hepatic sequestration.
- Kidneys - abnormalities may reflect chronic kidney disease affecting erythropoietin production and RBC maturation.
- Conditions commonly associated with abnormal results: Anemia (iron deficiency, B12/folate deficiency, hemolytic, aplastic), Leukemia and lymphomas, Infection (bacterial, viral, parasitic), Thrombocytopenia and bleeding disorders, Hemoglobinopathies (sickle cell disease, thalassemia), Myeloproliferative neoplasms.
- Potential complications of abnormal findings: severe anemia may cause tissue hypoxia and organ dysfunction; leukemia may progress rapidly; thrombocytopenia increases bleeding risk; parasitic infections may cause systemic complications if untreated.
Follow-up Tests
- Bone marrow aspiration and biopsy - indicated when peripheral smear shows abnormal blasts, severe anemia, thrombocytopenia, or suspected leukemia/lymphoma.
- Flow cytometry - recommended when abnormal cell populations are detected to identify cell lineage and diagnose leukemia or lymphoma.
- Iron studies (serum iron, ferritin, TIBC) - when microcytic hypochromic anemia is identified to determine iron deficiency.
- Vitamin B12 and folate levels - indicated when macrocytic RBCs with hypersegmented neutrophils are observed.
- Reticulocyte count - useful for assessing bone marrow response in hemolytic anemia or following blood loss.
- Hemoglobin electrophoresis - when hemoglobinopathy is suspected (sickle cell disease, thalassemia).
- Coagulation studies (PT, PTT, fibrinogen) - when platelet abnormalities or schistocytes suggest bleeding disorder or DIC.
- Parasitology studies - when parasites are identified on smear; may require additional stains (Wright-Giemsa, special stains for specific parasites).
- Cytochemical stains (MPO, PAS, Sudan Black) - for cell classification when malignancy is suspected.
- Repeat CBC and peripheral smear - monitoring frequency depends on diagnosis; typically weekly to monthly for ongoing treatment or chronic conditions.
Fasting Required?
- No fasting is required for peripheral blood smear examination. This is a non-fasting blood test.
- The test can be performed at any time of day without dietary restrictions or special preparation.
- Patient preparation: No special medications need to be avoided; all routine medications can be continued as prescribed.
- Additional preparation: Ensure adequate hydration and bring identification and insurance information. Report any recent blood transfusions or chemotherapy to the phlebotomist.
- Blood collection is from standard venipuncture into EDTA (ethylenediaminetetraacetic acid) tube, typically the same sample used for CBC analysis.
- Timing considerations: Sample should be examined within 24 hours of collection for optimal cell morphology, as cellular changes can occur with prolonged storage.

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