HealthFlex
×
  • Home
  • Immunology Book
  • Lab Tests
    • Hematology
    • Fluid analysis
    • CSF
    • Urine Analysis
    • Chemical pathology
    • Blood banking
    • Fungi
    • General pathology
    • Immune system
    • Microbiology
    • Parasitology
    • Pathology
    • Tumor marker
    • Virology
    • Cytology
  • Lectures
    • Bacteriology
    • Liver
    • Lymph node
    • Mycology
    • Virology
  • Blog
    • Economics and technical
    • Fitness health
    • Mental health
    • Nutrition
    • Travel
    • Preventive health
    • Nature and photos
    • General topic
  • Medical Dictionary
  • About Us
  • Contact

Red Blood Cell (RBC):- Part 2 – Normal Peripheral blood smear, and RBC Morphology

March 5, 2023HematologyLab Tests

Peripheral blood smear

Sample for Peripheral blood smear

  • To assess RBC morphology, make fresh smears and smears from the blood in EDTA.

Precautions for Peripheral blood

  1. A well-made smear is needed.
  2. A well-stained smear is also important.
  3. Otherwise, the analysis of cell morphology may be greatly distorted by poorly made and poorly stained smears.

Indications for Peripheral blood smear

  1. This is done to see the morphology of RBC as variation and abnormality in size, shape, structure, Hb contents, and staining characteristics.
  2. Can diagnose the type of Anaemia.
  3. Can diagnose Thalassemia.
  4. Also, it can find other abnormalities like hemoglobinopathies.
  5. This also helps to see the effect of chemotherapy and radiation.
  6. Special stains can find infections, infestation, leukemia, and other diseases.
Peripheral blood smear evaluates

Peripheral blood smear evaluates

Variation in the morphology of RBCs:

  1. There are various sizes and shapes of RBC seen in the peripheral blood smear:
  2. Normocytic when the size is normal (7 to 8 µm).
  3. Normochromic when the color is normal.
  4. Microcytic when the size is smaller than normal RBC, and these are less than 6 µm.
    1. In iron deficiency anemia and thalassemia, and hemoglobinopathies.
  5. Macrocytic when the size is larger than > 8 µm.
    1. Found in liver diseases, alcoholism, and oval in megaloblastic anemia.
  6. Anisocytosis is an abnormal variation in size from the normal diameter of 6 to 8 µm,  seen in severe anemia like iron deficiency, hemolytic anemia, and hypersplenism.
  7. Hypochromasia when the RBCs are pale with decreased Hb concentration.
  8. Poikilocytes, when RBCs have variation in shapes.
  9. Spherocytes when RBCs are round without the central pale area.
peripheral blood smear: RBC spherocytes

Peripheral blood smear: RBC spherocytes

  1. Elliptocytes when RBCs are oval or elongated.
    1. Found in hereditary elliptocytosis.
Peripheral blood smear: RBC Elliptocytes

Peripheral blood smear: RBC Elliptocytes

  1. Sickle cell is a crescent-shaped RBC seen in sickle cell anemia.
Peripheral blood smear: Sickle cell RBCs

Peripheral blood smear: Sickle cell RBCs

  1. The target cell is RBC, with a dark central area and clear space between this dark area and the periphery.
    1. Found in iron deficiency anemia, liver disease, post-splenectomy, and hemoglobinopathies.
Peripheral blood smear: RBC target cells

Peripheral blood smear: RBC target cells

  1. Schistocytes or helmet shape RBCs. These are irregularly contracted cells or fragmented RBCs.
  2. Burr cells are RBCs with spinous processes.
Peripheral blood smear: RBC burr cells

Peripheral blood smear: RBC burr cells

  1. Acanthocytes are RBCs with small cells with thorny projections.
      1. Found in liver disease, renal failure, and abetalipoproteinemia.
Peripheral blood smear: RBC acanthocyte cells

Peripheral blood smear: RBC acanthocyte cells

  1. Teardrop cell is RBCs with a tear-like appearance.
  2. The nucleated cell is RBC with the presence of a nucleus. These are normoblast or megaloblastic cells.
Summary of the peripheral blood smear

Summary of the peripheral blood smear

Red blood cells inclusion In the peripheral blood smears:

  1. Howell-Jolly bodies. These are spherical purple bodies within RBCs; these are nuclear debris.
  2. Heinz inclusion bodies. These are small round inclusion of denatured hemoglobin, seen with supravital stain or under phase microscopy.
  3. Siderocytes are the RBCs containing siderotic granules which stain blue with Prussian blue stain.
  4. Basophilic stippling is the presence of punctate stippling seen with the Wright stain.
Peripheral blood smear: RBC showing inclusions

Peripheral blood smear: RBC showing inclusions

Reticulocytes:

  1. Reticulocytes may also be seen in the peripheral blood smear.
  2. These are RBCs containing RNA and stained pinkish-blue in color. Methylene blue show a reticular network.
Peripheral blood smear: Reticulocytes

Peripheral blood smear: Reticulocytes

Rouleaux formation:

  • This typical formation is the pilling of RBCs on each other or aggregated RBCs.
Peripheral blood smear: RBC rouleaux formation

Peripheral blood smear: RBC rouleaux formation

Normal cells in the Peripheral blood:

  • Band form neutrophils = 2% to 6%
  • Neutrophils = 50% to 70%
  • Eosinophils  = 1% to 5%
  • Basophils = 0% to 2%
  • Lymphocytes = 20% to 44%
  • Monocytes = 2% to 10%

Interpretation of the peripheral blood smear:

  1. Screen the slide and note any abnormalities present in the smear regarding RBCs.
  2. It can evaluate the number or any abnormality of white cells.
  3. It can evaluate the number of platelets.
  4. So the peripheral smear gives the following information.
    1. Any abnormality of RBCs.
    2. Any abnormality in white cells.
    3. Can assess the number of platelets.

Various pictures of anemias:

  1. In hemolysis, hemorrhage, or in increased erythropoiesis. There are basophilic or polychromatophilic macrocytes
  2. Megaloblastic anemia shows oval macrocytes with increased lobules in the neutrophils.
  3. In hemoglobinopathies anemia, there are target cells, e.g., in thalassemia and Hb C.
    1. Target cells are also seen in iron- deficiency anemia and liver diseases.
  4. Thalassemia and lead poisoning show microcytes with stippling.

Red blood cells morphology and their etiology:

Type of RBCs abnormality Etiology for the abnormality
Microcytic            Anemia Microcytic hypochromic
  1. Iron-deficiency anemia
  2. Thalassemia
  3. Sideroblastic anemia
  4. Lead poisoning
Macrocytic           Anemia macrocytic megaloblastic
  1. Megaloblastic anemia
  2. Liver diseases
  3. Myelodysplastic syndrome
  4. Increased reticulocyte count
Spherocytes        RBC spherocyte
  1. Hereditary spherocytosis
  2. Hemolytic anemia
  3. Post transfusion
Target cells        RBC target cell
  1. Thalassemia
  2. Liver diseases
  3. Sideroblastic anemia
  4. Hemoglobinopathies
Teardrop cells   RBC tear drop poikilocyte
  1. Severe anemia
  2. Pernicious anemia
  3. Myeloproliferative anemia
Elliptocytes     RBC elliptocyte
  1. Hereditary elliptocytosis
  2. Thalassemia
  3. Iron-deficiency anemia
Sickle cells        Sickle cell RBCs
  1. Sickle cell anemia
  2. Sickle-thalassemia
Stomatocytes  RBC Elliptocyte
  1. Malignant tumors
  2. Acute alcoholism
Burr cells         RBC burr cells
  1. Renal diseases
  2. Liver diseases
  3. Bleeding gastric ulcer
  4. Severe burns
Acanthocytes  RBC acanthocyte
  1. Alcohol intoxication
  2. Post splenectomy
  3. Vitamin E deficiency
  4. Congenital abetalipoproteinemia
Hemet cells    RBC Helmet cell
  1. G-6-PD deficiency
  2. Pulmonary emboli
Schistocytes   RBC Schistocyte cell
  1. Hemolytic uremic syndrome
  2. Thrombotic idiopathic thrombocytopenia (ITP)
  3. Disseminated intravascular coagulopathy (DIC)
  1. Note please see more information on CBC and peripheral blood smear.

Questions and answers:

Question 1: What is the peripheral blood picture of thalassemia?
Show answer
Peripheral blood smear shows a hypochromic microcytic picture.
Question 2: What are the burr cells?
Show answer
Burr RBCs is with spinous process.

 


Possible References Used
Go Back to Hematology

Comments

kunjal gatecha Reply
August 28, 2020

very informative. thank you

Muhammad mustapha Abbas Reply
June 16, 2021

✌️✌️

Ahsan Reply
October 1, 2021

Good article. Shapes of some abnormal RBC type are missing that must be added.

Dr. Riaz Reply
October 2, 2021

Please, thanks for the comments. Can you specify missing abnormal cells?

jamal Reply
January 4, 2022

very well

Dr. Riaz Reply
January 5, 2022

Thanks.

Add Comment Cancel



The reCAPTCHA verification period has expired. Please reload the page.

  • Lab Tests
    • Blood banking
    • Chemical pathology
    • CSF
    • Cytology
    • Fluid analysis
    • Fungi
    • General pathology
    • Hematology
    • Immune system
    • Microbiology
    • Parasitology
    • Pathology
    • Tumor marker
    • Urine Analysis
    • Virology

About Us

Labpedia.net is non-profit health information resource. All informations are useful for doctors, lab technicians, nurses, and paramedical staff. All the tests include details about the sampling, normal values, precautions, pathophysiology, and interpretation.

[email protected]

Quick Links

  • Blog
  • About Us
  • Contact
  • Disclaimer

Our Team

Professor Dr. Riaz Ahmad Bhutta

Dr. Naheed Afroz Syed

Dr. Asad Ahmad, M.D.

Dr. Shehpar Khan, M.D.

Copyright © 2014 - 2023. All Rights Reserved.
Web development by Farhan Ahmad.