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
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
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