Teardrop cells dacrocytes american society of hematology. Brief communication case study interpretationhouston. Lymphocytosis 50% of leukocytes with the presence of at least 10% atypical lymphocytes and a positive serologic test of the epsteinbarr virus are typical laboratory findings in the epsteinbarr virus involvement. The blood droplet on the right is the preferred size. Anemia types and characteristic finding classification of. Peripheral blood smear, preparation, examination, interpretation, reporting, blood cells morphology. Uscap 99th annual meeting, washington, dc, march 20 26, 2010 laura robinson, maria gonzales, andy nguyen. Next generation sequencing of hematologic neoplasms. Interpreting peripheral blood smears harrisons principles of.
Dohle bodies may be seen in peripheral blood smears of patients with severe infections, and. An automated draft report generator for peripheral blood. They then tie a band above the venous site where your blood will be drawn. A synoptic reporting system for peripheral blood smear interpretation. To obtain an automated platelet count, obtain a blood specimen. An accurate peripheral blood smear report can elucidate a vast spectrum of hematologic disorders, guide further testing, and have a critical impact on patient care. The examination and interpretation of peripheral blood smears is an important component of clinical pathology. It consists of an automated microscope for capturing microscopic images of a blood sample, and a software component for analysis of the images. Teardrop cells may be seen in the setting of marrow infiltration by fibrosis, granulomatous inflammation, hematologic or metastatic malignancy, splenic abnormalities, megaloblastic anemia, and thalassemia. The blood droplet on the left is too big and will result in a thick smear. Atlas of hematology and analysis of peripheral blood. Serum is placed on a specific medium, and a charge is applied. Pdf analyzing microscopic images of peripheral blood. Synoptic reporting system for peripheral blood smear interpretation.
Pdf the peripheral blood film pbf is a laboratory workup that. Useful hemepath reference articles, selected reference articles in pdf format. Peripheral blood smear, preparation, examination, interpretation. Peripheral blood smear test procedure the blood smear test is a simple procedure in which your health care provider draws a blood sample from the vein in your arm.
Detecting disease states or syndromes of the white blood cells, red blood cells, or platelet cell lines of a patients peripheral blood. Peripheral blood smear from a patient with chronic myelogenous. Also important to remember is to air dry the blood smears with a rapid fanning of the slides. Premature destruction of erythrocytes occurs intravascularly or extravascularly. The common clinical indications for peripheral blood film pbf exposes the. Peripheral blood film or peripheral blood smear or peripheral smear examination forms an important and basic lab investigation for diagnosing a number of hematological blood disorders. Pathologist interpretation with written report will be added based on laboratory reflex criteria crystal id. Teaching the clinical interpretation of peripheral blood smears to a. Please send the edta tube of blood, when available, and submit the most current hematology results. Peripheral blood smear test purpose, procedure, results. Smears allowed to dry too slowly may result in perinuclear ring artifacts. The technique of obtaining the bone marrow specimen is very important.
Stained peripheral blood smear is examined carefully using 40 x to 100 x objective usually oil immersion lens 2. Water absorbed from the humid air into the alcohol based stain. In some ways it is becoming a lost art but it seems to us that you have your javascript disabled on your browser. The peripheral blood smear shows hypochromic and microcytic anemia. Interpretation skills routine tests complete blood count wbc differential count reticulocyte count peripheral blood smear routine morphology esr pt ptt mixing studies thrombin time ddimer and dic panel including fibrinogen level direct coombs test blood type and antibody screen lupus anticoagulant panel b12 and folate levels. One such instrument, the coulter counter, generates an electrical pulse when a blood cell passes through a small aperture surrounded by electrodes. Flow cytometry of blood, bone marrow, body fluids, lymph nodes, etc. We developed a computer program that automatically generates a pbs draft report based on cbc parameters and age and sexmatched reference ranges. Peripheral smear special instructions the test request form must be completed with patient history, including pertinent clinical information and physicians name and telephone number. The morphology and proportion of each blood cell type may change in various hematologic diseases.
We aimed to evaluate the use of digital microscopy for the examination of pbs as an option to provide expert interpretation to remote sites and in oncall situations. With the advent of hematological automated machines, complete and highly accurate hematological data and parameters like complete blood count or cbc can be obtained within a few minutes. Clinical pathology core rotation william winter, md. Rbcs with punchedout defects in their shapes are seen. To make a good blood smear, very little equipment is needed aside from practice in how to create a good smear and a good microscope. Circulating blood cells, including red blood cells rbcs, white blood cells wbcs, and platelets, are counted and sized electronically by modern instruments. While each study elucidates specific methods of detection, none of them provided an insight into the behavior and operation of the. Giemsa stain of blood smear taken from septicemic patient containing. This includes guidance regarding test selection and interpretation, and answering questions regarding operation of a clinical laboratory. A peripheral smear test can be used to diagnose, monitor numerous conditions and blood diseases that affect population of blood cells. The examination of a peripheral blood smear is one of the most informative exercises a physician can perform. Peripheral smears should be obtained before therapy has. Therefore, lymphopenia is often a presenting feature of t cell or combined immunodeficiency disorders such as severe.
Normal peripheral blood smear cll peripheral blood smear. A synoptic reporting system for peripheral blood smear. Sentinel laboratory guidelines for suspected agents of. Under normal conditions, the morphology and proportion of each blood cell type is fairly consistent in corresponding age groups. The peripheral blood smear pbs examination has direct diagnostic utility for certain groups of hematological and infectious diseases, such as leukemia, hemolytic anemia, and malaria, while providing adjunctive information to complete blood count cbc results. Blood bank physician service, difficult cross match andor.
The typical reporting format begins with the patients biodata, hospital. How to interpret and pursue an abnormal complete blood. Abnormal morphology of blood cells april 2012 hematologyimmunology system. Synoptic reporting system for peripheral blood smear. The smear showed numerous platelet clumps make sure to examine the edges of the smear since the clumps may migrate there. Blood smear, peripheral, interpretation by physician and report. The clinical presentation of primary immunodeficiency. Comparative analysis reveals potential utility of digital. This preserves cell morphology and helps to prevent clumping of the white blood cells and sample artifact. Evaluation of the peripheral blood smear pbs is an essential diagnostic test in current medical practice. The etiologies of hemolysis often are categorized as acquired or hereditary.
Peripheral blood smear examination is a means to suggest a range of diagnoses or likely diagnosis. Peripheral blood smear, preparation, examination, interpretation, reporting. The technique used to make the blood smear is extremely. This paper presents a new automated peripheral blood smear analysis system, shonit 1. Clinical findings varies with the volume of blood loss and the time period over which blood is lost acute pallor, then cyanosis and desats shallow, rapid, irregular respirations weak or absent peripheral pulses low or absent blood pressure hemoglobin may be normal initially, with rapid decline over 4. A blood film or peripheral blood smear is a thin layer of blood smeared on a microscope slide. Peripheral blood smear procedure and interpretation. Volume of packed red blood cells per unit of blood, expressed as a percentage. This has motivated researchers to develop different algorithms and methods to automate peripheral blood smear image analysis. View issue toc volume 80b, issue 4 julyaugust 2011 pages 255257. Another smear may be prepared for referral to the state public health laboratory. Common problems are the biopsy being too small or fragmented or it includes cartilage and bone rather than marrow. Finally, anabnormalcbc should be interpreted within the context of an individuals baseline value because up to 5% of the general population without disease may display laboratory values outside the statistically assignednormal reference range table 1. Detecting disease states or syndromes of the white blood cells, red blood cells, or platelet cell lines of a patients peripheral blood additional tests lists tests that are always performed, at an additional charge, with the initial tests.
A blood smear is used to diagnose andor monitor numerous conditions including appropriate number and morphology of white blood cells wbcs, red blood cells rbcs, andor platelets plt. It is therefore helpful for laboratories to establish rules for pbsr. Many descriptions in pbs reports may simply be translated from cbc parameters. The best place to examine blood cell morphology is the. The net charge positive or negative and the size and shape of the protein commonly are used in differentiating various serum proteins. Next generation sequencing of hematologic neoplasms todd w. Teardrop cells in a peripheral blood smear from a patient whose bone marrow was extensively replaced by b lymphoblastic leukemia. Peripheral blood interpretation 85060 clot 88305 bone marrow aspirate smear interpretation 85097 core 88305 decalci cation 88311 additional studiesspecial stains 8831 iron and reticulin ihc global marker number 88342 varies but typically 04. Links for pdf files of selected abstracts and articles. Acute pure erythroid leukemia with fulminant hemophagocytosis.
Authorization for deviation from standard blood bank procedure with written report. The manual examination of these images is tedious, timeconsuming and suffers from interobserver variation. Complete blood count cbc results play an important role in peripheral blood smear pbs examinations. A phlebotomist, a person specifically trained to draw blood, first cleans and sterilizes the injection site with an antiseptic. Pdf an automated draft report generator for peripheral. Differential leukocyte countspecial smear evaluation is helpful in revealing the changes in morphology or proportion of each cell type in the peripheral blood. There were no giant platelets, fragmented rbc, or small rbc. Cpt hcpcs code description frequently used procedures. Generation of fastq files raw data ngs workflow sequencing of the clonal amplicons pairedends. Peripheral blood smear image examination is a part of the routine work of every laboratory.
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