blood smear

Overview

  • look in monolayer region, red cells not overlapping but almost touching

Terminology

  • background: not significant
  • trace: not totally confident real finding
  • 1+ first step with confidence abnormal
  • 4+ most ever seen

RBC

  • anisocytosis: varied size
  • poikilocytosis: varied shape

AIHA

  • spherocytosis, AIHA
  • reticulocytosis: slightly larger and darker, multiple RBC size/colors

  • Direct: patient RBC, patient antibody
  • Indirect: patient antibody only. React with transfused RBC

Examples

  • rouleaux

  • IDA
  • RBC should be size of lymphocyte nucleus, smaller here
  • over-represented central pallor

  • tear drop cells, dacrocytes
  • evidence of marrow invasion

  • TTP
  • MAHA

WBC

  • CLL, mature lymphocytes

  • different white cells
  • CML: varying maturation, whole spectrum of maturation

  • blasts, high nucleus to cytoplasm ratio
  • ALL

  • APL, AML
  • give ATRA