Full Blood Picture
Morphology of Blood Cells
Definition FBP = FBC + Differential count (DC) + Histogram + Peripheral Blood Film (PBF) FBP = Haemogram + PBF
Erythrocytes Normal morphology (normocytosis (normocytosis normochromia) normochromia) (non (non -poikilocytic, -poikilocytic, poikilocytic) Anisocytosis (microc (microcytosis, ytosis, macro macro cytosis) Poikilocytosis Anisochromasia (hypochromia, (hypochromia, hyperchromia) hyperchromia) Polychromasia Dimorphism
Haemogram = FBC + DC + Histogram FBC = CBC = Complete Blood Count
Concept Haemopoiesis Haemopoiesis occur in Bone Bone Mar row Mature cells circulate in periphery periphery Pathological process in marrow is reflected reflected in peri phery Extramedullary Extramedullary pathology can cause abnormal peripheral blood picture Based on Morphology, Counts Indications Clinical suspicion of bl ood disorders Severe anaemia prior prior t o blood transfusion transfusion Abnormal FBC/ Histogram Assessment of known blood disorders Routine medical examination
Inclusion bodies Nucleated Nucleated r ed cells Agglutination Rouleaux Rouleaux f ormation Classification of Poikilocytes Round Spherocytes Stomatocyte
Elongated Ovalocytes/ elliptocyte Teardrop cells
Spiculated Spiculated Schistocytes Schistocytes Keratocyte
Target cell cell
Sickle cell Hb C crystalloids HB S-C hybrids
Echinoc Echinocytes ytes Acanthocytes Acanthocytes
Reporting RBC RBC : Hb level + Morphology + Other WBC : Counts + Morphology + Others Platelet : Counts Counts + M orphology orphology Impression :
Inclusions Inclusions in Erythrocytes Howell-Jolly Bodies Bodies Basophilic Basophilic S tippling Pappenheimer Bodies Malarial Parasit Reticulocyte
Suggestion : Blood Film in Healthy Subjects Healthy Adults Slig ht Anisocytosis/ Anisocytosis/ Poikil ocytosis Metamyelocytes/ My elocytes – rare Megaka ryocytes ryocytes – very very rare RBC : Platelet = 10-40 : 1 Pregnancy More variation ↑ MCV (30-35 weeks) ↓ Hb (30-34 weeks) ↑ ESR (Rouleaux) Numerous Numerous polychro matic cells ↑ Retic. Count (6% at 25-30 weeks) ↑ Neutrophil/ Monocyte count Left Shift Platelet - Count/ Size usually do not change Infant & Children Children MCV/ MCH ↓ compared to adults Male- Female hav e difference difference in Hb (RBC, PCV/Hct not present before puberty) Lymphocyte count ↑
Heinz Bodies
Leucocytes
Neonate Hyposplenic Hyposplenic features – Howell-Jolly Bodies, Bodies, Acanthocytes, S pehrocytes pehrocytes Hb, RBC, PCV ↑ MCV ↑ Neutrophil, Monocyte, Lymphocyte counts ↑ NRBC & Myelocytes – common st Retic. Count ↑ in 1 3 days a fter birth Premature Neonate Neonate ↑ NRBC, NRBC, Meta myelocytes, myelocytes, Myelocytes, Promyelocytes, Promyelocytes, Myeloblasts Hyposplenic features nd rd Develop eosinophilia often (between 2 – 3 weeks after birth) Hyposplenism After splenectomy – Thrombocytosis, Neutrophilia After Recovery – Neutrophil counts nearly Normal, Platelet high Normal Lymphoc Lymphocytosis, ytosis, Monocytosis persist Abnormal RBC features Target cells Acanthocytes Howell-Jolly bodies Pappenheimer bodies NRBC Spherocytes Circulating Circulating non-haemopoietic non-haemopoietic cells Endothelial Endothelial cells Epithelial Epithelial cell cell Non-haemopo Non-haemopoietic ietic malignant cells
Microorganisms Microorganisms in Blood Blood Film Bacteria Fungi Parasite
Platelets/ Thrombocytes Thrombocytes Normal Large Giant Platelet clumps clumps Platelet satellitism satellitism
