Red Blood Cell (RBC):- Part 3 – Peripheral Blood Smear Interpretations

Sample

• The blood sample may be in the EDTA or make a fresh blood smear.

Indications

1. Peripheral blood smear gives very significant findings of RBC and white cells.
2. To see the effects of drugs on RBC and white cells.
3. To find the congenital abnormalities of the cells.
4. To find the acquired abnormalities of the cells.
5. A peripheral blood smear can give information about acute and chronic infection, infestation, leukemia, and etc.

Pathophysiology

1. The differential count on the peripheral blood smears gives us information for Anaemias or leukemias and any other abnormality of the blood cells.
2. DLC and CBC are less expensive, easy to perform, and can be done in a short time.
3. Peripheral blood smear under the expert eye can give information about the three cellular components like RBC, white cells, and platelets.
4. All the types of leukocytes can be differentiated and can find any abnormality.
   

   Peripheral blood smear evaluation

RED Blood Cells abnormalities:

RBC size abnormality;

1. 1. Microcytes, these are small in size.
      1. these are seen in iron deficiency anemia, hereditary spherocytosis, and thalassemia.
   2. Macrocytes, these are large in size and seen in:
      1. Vit B12 or folic acid deficiency.
      2. Liver disorders.
      3. Post Splenectomy anemia.

RBC shape abnormality:

1. 1. Spherocytes, are small and round in shape. Also, these are thick red blood cells.
      1. Hereditary spherocytosis.
      2. acquired immune hemolytic anemia.

1. 2. Elliptocytes, These are sickle-shaped or oval shape RBCs,  and also called as pencil-shaped cells, these are seen in:
      1. Hereditary elliptocytosis.
      2. Sickle cell anemia.

3. 3. Target cells, these have a dark spot in the center and these are seen in:
      1. Thalassemia.
   4. 1. Hemoglobinopathies.

1. 4. Spiculated RBC, has a rough surface or crenated in shape and are seen in:
      1. Seen in uremia.
      2. liver diseases.
      3. In bleeding ulcers.
   5. Spur cell is seen in severe liver diseases
   6. Burr cells These are irregularly contracted red cells. These are seen in :
      1. Renal diseases.
   7. Fragmented cells are seen in :
      1. DIC.
      2. Post-splenectomy.
      3. Patient with a heart valve prosthesis.

RBC staining or color abnormalities:

1. 1. This will show the staining character of the cells.
      1. Hypochromasia,  when the RBC are pale in color e.g.
         1. Iron deficiency anemia.
         2. Thalassemia.
      2. Hyperchromasia is increased in color intensity e.g.
         1. Seen in dehydration.
         2. The increased concentration of hemoglobin.

Red blood cell intracellular abnormalities:

1. 1. Normoblast is not seen normally on peripheral smear. These are seen in :
      1. Normoblast may be seen in the newborn.
      2. Hemolytic anemias.
      3. Sickle cell crises.
      4. Transfusion reaction.
      5. Erythroblastosis fetalis.
      6. Marrow space-occupying lesions like Myeloma, leukemia, and fibrosis.
      7. In physiologic response to hypoxia as in congenital heart disease and congestive heart failure.
   2. Basophilic stippling: These are the inclusion in the cytoplasm of RBC e.g.
      1. Lead poisoning.
      2. Reticulocytosis.
   3. Howell-Jolly bodies: These are remnants of nuclear material in the RBC e.g.
      1. In patients with splenectomy.
      2. Hemolytic anemia.
      3. Megaloblastic anemia.
   4. Heinz bodies are small irregular part of hemoglobin e.g.
      1. Seen in hemoglobinopathies.
      2. hemolytic anemia.
      3. G 6 PD deficiency.
      4. Drug-induced injury to RBC.
   5. Dimorphic red cells This is a feature of sideroblastic anemia.
      1. Also seen in a patient with post-transfusion

White blood cells

It can be estimated in number, differential count and any abnormality of the maturity can be evaluated.

1. For leukemia, one will see more immature cells.
2. The decreased count will indicate bone marrow depression.
   1. This may be due to drugs.
   2. Fibrosis of the marrow.
   3. Neoplasm.

Platelet count

This can also be estimated from the smear.

1. Thrombocytopenia when the platelets are seen in less number on the smear.
   1. Idiopathic thrombocytopenic purpura ( ITP ).
   2. Hypersplenism.
   3. Hemorrhage.
   4. Leukemia.
   5. Myelofibrosis.
   6. Cancer chemotherapy.
   7. Inherited disorders like Wiskott-Aldrich syndrome.
   8. D I C.
   9. Systemic lupus erythematosus.
   10. Infections may be bacterial or viral.
2. Thrombocytosis when there is an increased number of platelets on smears.
   1. This may be seen in:
      1. Infection.
      2. Some leukemias and lymphomas.
      3. In splenectomy.
      4. POlycythemia vera.
      5. Rheumatoid arthritis.

• Please, for more details see in the differential count ( CBC ) and RBCs morphology.

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