Blood Film

OVERVIEW

• peripheral blood film can provide useful information in diagnosing haematological conditions

ERYTHROCYTE BLOOD FILM FINDINGS

• Acanthocytes aka spur cells — spiky or thorny appearing RBCs
  (liver disease, abetalipoproteinemia – also splenectomy, hypothyroidism, myelodysplasia)
• Anisocytosis – variation in cell size
  (iron deficiency, thalassaemia, megoblastic)
• Blister cells — small blebs or blisters on the surface of RBCs
  (oxidative damage in G6PD deficiency)
• Dohle bodies – light blue-gray oval, basophilic, leukocyte inclusions located in the peripheral cytoplasm of neutrophils
  (often present in conjunction with toxic granulation)
• Fragmented cells – microangiopathic haemolytic anaemia
  (MAHA)
• Heinz bodies – oxidative stress
  (G6PD deficiency, drugs: primaquine, alpha thalasaemia, chronic liver disease, splenectomy)
• Howell-Jolly bodies – remnants of nuclear proteins
  (post-splenectomy, megaloblastic, leukaemia)
• Pappenheimer bodies – granules of iron in RBCs
  (siderblastic anaemia)
• Polychromasia – bluish or grayish RBC
  (immature RBC’s in circulation)
• Reticulocytes – compensation for acute blood loss or any cause of red cell destruction
  (haemolysis)
• Rouleaux – stacking together of RBCs on top of each other due to acute phase proteins; correlates with high ESR
  (infection, inflammation, active disease)
• Schistocytes aka helmet cells – fragmented parts of RBCs
  (microangiopathic disease, haemolysis e.g. mechanical, TTP)
• Spherocytes – sphere shaped RBCs
  (auto-haemolytic anaemia, hereditary)
• Target cells aka codocyte – ring of pallor with a central and peripheral rib of staining
  (chronic liver disease, sickle cell disease, thalassaemia, post-splenectomy)
• Toxic granulation, vacuolation, left shift, band forms, metamyelocytes – suggests an active inflammatory/infective process

PLASMA CELLS

Hematological conditions

• Multiple myeloma
• B cell lymphoma
• Plasmocytoma
• Spherocytosis
• Serum sickness
• Plasma cell leukaemia
• MGUS
• Waldenström macroglobulinemia

Infections

• Varicella zoster infection
• TB
• Leprosy
• Hepatitis Active/chronic HBV

NUCLEATED RED BLOOD CELLS

• Hyposplenism
• Compensatory erythropoeisis with anaemia
• Hypoxia
• Marrow replacement/ invasion
• Extramedullary haematopoeisis
• Erythropoietin abuse
• Other – uraemia, sepsis, liver disease, renal transplant, thermal injury chemotherapy