Algorithm for Blood Smear Examination

· Automated differential

· 10x objective:

· Distribution of blood cells

· Quality of the smear

· Quality of the stain

· Examine lateral edges, feather edge, and readable area next to the feather edge

· Evaluate for clumping (platelets, RBCs, WBCs)

· 50x or 100x oil objective:

· Differential count (note large cells tend to be drawn towards the edges)

· RBC morphology:

· Acanthocytes

· Anisocytosis

· Basophilic stippling

· Burr Cells

· Howell-Jolly Bodies

· Hypochromia

· Macrocytes

· Microcytes

· Normocytic

· Ovalocytes

· Poikilocytosis

· Polychromasia

· Schistocytes

· Spherocytes

· Target cells

· Teardrops

· WBC morphology:

· Auer rods

· Blasts

· Dohle bodies

· Hypogranularity

· Hypersegmentation

· Pseudo-Pelger-Huet anomaly

· Toxic granulation

· Atypical lymphocytes

· Vacuoles

· Platelets:

· Quantity (increased, decreased, adequate)

· Clumping

· Giant forms

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References:

· Gulati G, Caro J. Blood cells: an atlas of morphology (2007)

· Steven H. Swerdlow. University of Pittsburgh School of Medicine Department of Pathology. Hematopathology handbook for residents and fellows.

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