YASSER

1
???? ???? Blood smear
2
????? ???? ????

• ?????? ????? ?????????? ?????? WBC? RBCs ? PLT
• ???? ????? ?? ????? ?????? ????? ?? ?????
  ???????? ????
• ???? ????? ?? ????? ????? ???? ???? ????? ???????
  ?? ???????
• ?????? ???? ?? ??? ?? ????? ???? ??????? WBCs

3
????? ???? ????

1. ????? Blood film
2. ??????? Fixation
3. ????? Staining
4. ????? Exam

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??? ??????
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5 - 10 ul Fresh Whole blood
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tail body head
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?????? ?? ?????

• Size of blood drop
• Too much blood makes the blood film thicker
• Too low blood and the smear will be too thin
• Angle
• Too high and the smear will be too thick
• Too low and the smear will be too thin
• Speed
• high speed and the smear will be too thick
• low speed and the smear will be too thin
• Pressure on the push slide
• low Pressure and the smear will be too thick
• high speed and the smear will be too thin

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???? ???? ??????
11
????? ??? ???? ????

• ??? ???????
• ??? ??????? ???????? ??? ??? ????
• ????
• ????? ????? ?????? ????

12
????? ??? ???? ????

• ??? ???????
• ?????? ???? ?? ?????? ????? ???? ???????
• ????
• ?????? ??? ???? ????? ????? ??????

13
????? ??? ???? ????

• ??? ???????
• ??????? ???????? ?????
• ????
• ????? ?????? ?????

14
????? ??? ???? ????

• ??? ???????
• ???? ???? ?????
• ????
• ??????? ???? ?? ????

15
????? ??? ???? ????

• ??? ???????
• ??????? ?? ????? ??????? ??? ?????? ???? ????
  ??????
• ????
• ????? ???? ???? ???? ?????? ??? ????? ???????

16
????? ??? ???? ????

• ??? ???????
• ????? ????? ?? ????? ??? ??????? ???????
• ????
• ??? ??????? ?? ??????? ?????? ??? ?????
• ?? ????? ???? ???????
• ?? ?????? ?????? ??????
• ?? ????? ??????? ???????? ???????? ???????? ????
  ???????

17
????? ??? ???? ????

• ???????
• ?????? ??? ??????
• ????
• ????? ???? ??????? ??? ??? ?????? ?????? ???????
  ??????? ????????

18
????? ??? ???? ????

• ??? ???????
• ?????? ?? ????? ???? ????
• ????
• ??? ?????? ?? ????? ??????? ??? ?????

19
????? ?? ????? ????? ?? ?? ????? ??????

• Cold agglutination - RBCs will clump together.
• Warm the blood at 37 C for 5 minutes, and then
  remake the smear.
• Lipemia - holes will appear in the smear. There
  is nothing you can do to correct this.
• Rouleaux - RBCs will form into stacks resembling
  coins. There is nothing you can do to correct
  this

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????? ??????
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(No Transcript)
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• ??? ????? ??????? ???? ???????? ??? ?? ??????
• ????? ??????? ??????
• ????? ????? ???? ??? ???? ???? ?? ????? .. ????
  Crenated
• ????? ???? ????? ?? ?????? ????????
• ??????? ?????? ??? ??? ???? ??????? ?? ???? ?????
  ???? ?? ???????

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??? ??????
25
???? ?????

• Wrights Stain
• Methylene blue
• Basic
• stains acidic and basophilic cellular components
• Stain Nucleus
• Eosin
• Acidic
• stains basic and eosinophilic
• Stain eosinophilic granules

26
.A ??????? ?????? ??????? ???? ??????
???? ???? ???? ????
?? ???? ??????? ????
27
????? ??? ???? ???? Blood film

• .A ??????? ?????? ???????? ???? ??????
• ???? ??????? ?? ??? ????? ??? ???? ?????? ????
  ??????? (?? ???? ??? ???? ?????? ????? ??????)
• ??? ????????? ???? ???? ?????? ?? ????? ??? ?????
  ?????? ?? ???? ??????? 5 7 ????? ?? ??????
  ????????
• ???? ??????? ??????? ?????? ????
• ???? ????? ?????? ?? ??????? ?????? ?? ????
  ??????
• ??? ??????? ?? ??? ???? ??? ????

28

1. ??????? ??????? ???????? Rapid stain

???? ???? ???? ????
?? ???? ??????? ????
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NORMAL PERIPHERAL BLOOD Cells
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PLATELETS
31

1. ?????? ??????

1. ?????? ??????

1. ?????? ??????

32

• ?????? ?? ?????? ?? ????
• ????? ?? ????? ????? ?? ???? ?? ?????? ?????? ???
  ???
• ???? ????? ?????? Ph
• ??? ?????
• ???? ????? ?? ??????
• ??? ?????? ??? ?????
• ???? ??????? ?? ?????? (??? ????? ?????? ???
  ?????????)

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??? ??????
35
tail body head
36
????? ?????

• ????? ??????? ??????? ???????? ??? ????

37
??? ????
38
??? ????
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(No Transcript)
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41
???? ????????

• ?????? ???? ?? ??? ?? ????? ???? ??????? WBCs
• ??? ?? ????? 100 ???? ?????
• ?? ?? ??? ????? ???? ?? ?? ???? ??????? ???
• ???? ?? ??? 50 ???? ????? ???? 30 ???? ????????

42
Differential count
Neutro
Lympho
Mono
Eosino
Baso
43
????? ????? ???? ????????

• WBCs
• Neutrophil
• Band
• Segmented
• Eosinophil
• Basophil
• Lymphocyte
• Small
• Large
• Monocyte

• Rbcs

• Platelet

44
RBCs

• ??? ??????
• 7 to 8 µm
• ??????
• ?? ???? ????
• ???????????
• ???? ??? ??? ????????? ?? ????
• ???? ???? ????? ???? ??? ?? ??? ??????

45
Microocytic Hypoochromic
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Microocytic Hypoochromic
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Macrocytic hyperchromic
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Macrocytic hyperchromic
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Neutrophil (Segmented)

• ??? ??????
• ????? 10 - µm 15
• ??????
• ?????? ????? ?? 2 5 ???? ???? ?? ????? ?????
  ????????
• ?????? ????? ?? ??????
• ???? ?????? ??? ???? ???????????
• ??? ??????????? ???? ?? ??? ??????
• ?????? ???????????
• ??Granules ?????
• Neutrophilic
• ??????? ???? ?????? ??? ??????
• ???? ???????????
• (??? ??????????? ????)

All WBCs
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Neutrophil (Segmented)
All WBCs
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Neutrophil (Banded)

• ??????
• ?????? ?????? ????????? ????
• ?????? ??? ?????
• ?????? ????? ?? ?????? (Nucleoli))
• ??? ??????
• ????? 10 - µm 15
• ???? ?????? ??? ???? ???????????
• ??? ??????????? ???? ?? ??? ??????
• ?????? ???????????
• ??Granules ?????
• Neutrophilic
• ??????? ???? ?????? ??? ??????
• ???? ???????????
• (??? ??????????? ????)

All WBCs
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Neutrophil (Banded)
All WBCs
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Eosinophil

• ??? ??????
• ????? 10 - µm 15
• ??????
• ?????? ????? ?? ???? ??????? 3 ???? ???? ?? ?????
  ????? ????????
• ?????? ????? ?? ?????? (Nucleoli)
• ???? ?????? ??? ???? ???????????
• ??? ??????????? ???? ?? ??? ??????
• ?????? ???????????
• ??Granules ?????
• Eosinophilc
• ???? ?????? ???????? (Eosine)
• ???? ???????????
• (??? ??????????? ???? ???????)

All WBCs
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All WBCs
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Bosophil

• ??? ??????
• ????? 10 - µm 15
• ??????
• ?????? ????? ?? ???? ??????? 3 ???? ???? ?? ?????
  ????? ????????
• ?????? ????? ?? ?????? (Nucleoli)
• ???? ?????? ??? ???? ???????????
• ??? ??????????? ???? ?? ??? ??????
• ?????? ???????????
• ??Granules ????? ???
• Bosinophilc
• ???? ?????? ???????? (Methylene Blue)
• ???? ???????????
• (??? ??????????? ???? ??????)

All WBCs
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All WBCs
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Small Lymphocyte

• ??? ??????
• ????? 8 - µm 12
• ??????
• ?????? ????? ?????
• ?????? ????? ?? ?????? (Nucleoli)
• ???? ?????? ??? ???? ???????????
• ??? ?????? ???? ?? ??? ???????????
• ?????? ???????????
• ??????????? ??? ????
• ???? ???????????
• ????? ???? ????

All WBCs
58
Small Lymphocyte
All WBCs
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Large ymphocyte
All WBCs
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Reactive Lymphocyte (Abnormal)

• ??? ??????
• ????? 12 - µm 20
• ?? ???? ?????? ??? ???? ????????? ???? ??????
  ???? ???? ??????? ??? stretched
• ??????
• ?????? ????? ?????
• ?????? ????? ?? ?????? Nucleoli))
• ???? ?????? ??? ???? ???????????
• ??? ?????? ???? ?? ??? ???????????
• ???????????
• ??????????? ?? ?????? ????? ??????? ?????
• ?? ???? ?????
• ???? ???????????
• ????? ???? ????

All WBCs
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Reactive Lymphocyte (Abnormal)
All WBCs
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Lymphocyte (Large)
Lymphocyte (Reactive)
Lymphocyte (Small)
All WBCs
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Lymphocyte (Large)
Blast cell
Lymphocyte (Reactive)
Lymphocyte (Small)
All WBCs
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Monocyte

• ??? ??????
• 12 to 20 µm
• ??????
• ?????? ??? ?????? ???? ??? ?????? ?? ???? ??????
• ?????? ????? ?? ?????? (Nucleoli))
• ???? ?????? ??? ???? ???????????
• ??? ?????? ???? ?? ??? ???????????
• ???????????
• ??????????? ???? ?????? ????? ???
• ???? vacuoles ?? ????? ?? ???????????
• ???? ???????????
• ????? ???? ????

All WBCs
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All WBCs
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All WBCs
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All WBCs
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• WBCs
• Neutrophil (Segmented)
• Neutrophil (Banded)
• Eosinophil
• Bosophil
• Lymphocytes
• Small Lymphocyte
• Large ymphocyte
• Reactive Lymphocyte (Abnormal)
• Monocyte

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• Do not count cells that are disintegrating !!!
• Eosinophil with no cytoplasmic membrane and with
  scattered granules
• smudge cells
• Basket cells
• Pyknotic cell (nucleus extremely condensed and
  degenerated, lobes condensed into small, round
  clumps with no filaments interconnecting).

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Quality control in blood film
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??
RBC
Lymphocyte
Neutrophil
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Echinocytes  (burr cells)

• Chronic kidney disease
• Myeloproliferative disorders
• Excess washing
• EDTA arifacts

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Target Cells (Codocytes)

• Thalassemia
• Hemoglobinopathy
• Excess washing

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Wrong exam site or thick film
Cold agglutination
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Rouleaux formation
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Rouleaux
Wrong exam site or thick film
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Quality control in blood film

• ????????
• ?????? ???? ?????? ???? ????? ?????
• ?????? ????????
• ??? ???? CBC ?????? ????? .. ?? ??????? ??????
• ??? ??? ??? ????????
• ??? ??????? ???? ???? ???
• ??? ???? ??? ???? ??? ??????? ??????
• ??? ???? ????? ??? ????? ???? 100

86
????? ??? ???????

• ??? ????? ?? ????? ??? ???
• ????? ?????
• ?????? ??? ??????????? ??? ??????? ??????
• ????? ???????
• ?????? ??? ??????????? ?????? ????? ???????
  ??????? ??? ?????
• ????? ?????
• ?????? ??? ??????????? ?????? ????? ???????
  ??????? ?????? ????? ???????

87
Quality control in blood film

• ??? ??? ????? ?????? ?? ??????? ???????? ????
  ??????? ???????? ?? ?????? ??????? ????????
• ??? ????? ?? ?????? ???????
• ??? ???? ??? ?? ????????
• ?????? ????? ??????? ??? ???????
• ????? ????? ???? ????

88
????? ???? ????

• ???? ?? ?????? ???? ???? ????
• ??? ?? ??? ????? ???? ????
• ????????
• ???? ??? ???? ???????
• ??????
• ???? ???????

89
(No Transcript)
90
????? ???? ????

• ???? ?????? ??? ?????
• ??? ?? ??? ????? ???? 2 ??? 3 ???? ??? ????
• ????????
• ??? ???? ?? ????? ???????
• ??????
• platelet satellitosis

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92
????? ???? ????

• ???? ?? ?????? ??? ?????
• ????????
• ???? platelet satellitosis
• ??????
• ?? ????? ?????? ??????????? ???? ????

93
??????? ???? ????? ????
Cell Type ????? Increases Decreases
Neutrophil ???????? Neutrophilia Neutropenia
Eosinophil ????????? Eosinophilia N/A
Basophil ??????? Basophilia N/A
Lymphocyte ????????? Lymphocytosis Lymphopenia (lymphocytopenia)
Monocyte ???????? Monocytosis Monocytopenia
Leucocytes ?????? ??????? Leucocytosis Leucocytopenia
Thrombocytes ??????? ??????? Ehrombocytosis Thrombocytopenia
Erythrocyte ?????? ??????? Erythrocytosis Erythrocytopenia (Anemia)
????? ?? ??????? Polythycemia
??? ?? ??????? Pancytopenia
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The END
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•  The main difference in morphology of T- and
  B-lymphocytes is found to be the larger mean
  diameters of the latter
• activated B cells can give rise to
  antibody-producing cells and some activated T
  cells become cytotoxic T cells.

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Lymphocyte (Large)
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Neutrophils have two types of granules primary
(azurophilic) granules (found in young cells)
and secondary (specific) granules (which are
found in more mature cells). Primary granules
contain cationic proteins and defensins that are
used to kill bacteria, proteolytic enzymes and
cathepsin G to break down (bacterial) proteins,
lysozyme to break down bacterial cell walls,
and myeloperoxidase (used to generate toxic
bacteria-killing substances).13 In addition,
secretions from the primary granules of
neutrophils stimulate the phagocytosis
of IgG antibody-coated bacteria.14 The
secondary granules contain compounds that are
involved in the formation of toxic oxygen
compounds, lysozyme, and lactoferrin (used to
take essential iron from bacteria)