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1. Dept. of Haematology & Blood Transfusion, University of Benin Teaching Hospital, Benin City, Edo State
2. Dept. of Haematology & Blood Transfusion, University of Calabar Teaching Hospital, Calabar, Cross
River State
Correspondence: ABSTRACT
Dr. A.S. Adewoyin The peripheral blood film (PBF) is a laboratory work-up
Dept. of Haematology and Blood Transfusion, that involves cytology of peripheral blood cells smeared
University of Benin Teaching Hospital, on a slide. As basic as it is, PBF is invaluable in the
PMB 1111, characterization of various clinical diseases. This article
Benin City, Edo State highlights the basic science and art behind the PBF. It
E – Mail: doctordemola@gmail.com, expounds its laboratory applications, clinical indications
Phone: 07033966347 and interpretations in the light of various clinical diseases.
Despite advances in haematology automation and
application of molecular techniques, the PBF has remained
a very important diagnostic test to the haematologist. A
good quality smear, thorough examination and proper
interpretation in line with patient’s clinical state should
be ensured by the haemato-pathologist. Clinicians should
be abreast with its clinical utility and proper application
of the reports in the management of patients.
Keywords: Peripheral blood smear, Preparation, Examination, Interpretation, Reporting, Blood cells morphology.
INTRODUCTION
In patient care, diagnostic formulations rest on a tripod INDICATIONS FOR A PERIPHERAL
consisting of clinical history, physical examination and BLOOD FILM
laboratory investigations. The Literature reveals that Initiation of a PBF is often a clinical request by the
as much as 70% of clinical decisions and diagnoses attending clinician on account of a clinical suspicion
are supported by laboratory medicine. 1 Peripheral or less frequently initiated by the laboratory.2, 3 The
blood film (PBF) is a basic and a highly informative laboratory may initiate peripheral blood film based
haematological tool at the clinician’s disposal in on abnormal findings from an automated count or
screening, diagnosis and monitoring of disease patients clinical information whose diagnosis may be
progression and therapeutic response. An adept supported by a peripheral blood film. The latter is
understanding of peripheral blood interpretation is guided by individual laboratory policies or local
important for a successful clinical practice. regulating guidelines.2
The diagnostic relevance of a PBF is enormous. The Common clinical indications for peripheral blood film
PBF exposes the morphology of peripheral blood analysis include unexplained cytopenia: anaemia,
cells, which ensures its place in the morphologic leucopenia or thrombocytopenia; unexplained
diagnosis of various primary and secondary blood leukocytosis, lymphocytosis or monocytosis;
and blood related diseases. It’s diagnostic relevance has unexplained jaundice or haemolysis; features of
not been lessened by advances in haematology congenital haemolytic anaemias such as splenomegaly,
automation and molecular techniques. jaundice or bone pains; suspected chronic or acute
myeloproliferative disease e.g. chronic myeloid
This article attempts to summarize the preparation and leukaemia; suspected organ failure such as renal disease,
reporting of peripheral blood film, its clinical liver failure; features of hyperviscosity syndrome as in
interpretations and the common peripheral blood paraproteinaemias, leukaemic hyperleucocytosis,
diagnosis. This will enhance the understanding of PBF polycythaemia; severe bacterial sepsis and parasitic
interpretations by Clinicians. infections; malignancies with possible bone marrow
involvement; suspected cases of nutritional anaemia;
Target cells (codocytes, mexican hat cells) Sickle cell disease, haemoglobin C trait, haemoglobin CC
disease, thalassemias, iron deficiency, Liver disease
(cholestasis), asplenia,
Basket cells (half ghost cells/Blister cells) Oxidant damage, G6PD deficiency, Unstable haemoglobins
Spherocytes Hereditary spherocytosis, ABO incompatibility,
Autoimmune hemolytic anemia (warm antibody type),
Severe burns
deficiency. Siderotic granules or pappenheimer bodies ball’ appearance of the erythrocytes. Red cells with
appear purple on Rowmanosky stain, blue on Perl’s bluish reticular fragments (ribosomal proteins and
stain and are seen in disorders of iron utilization like RNA) on supravital staining are reticulocytes.
sideroblastic anaemias. Intracellular parasites such as Reticulocytes appear as polychromatic cells on
plasmodium or babesia may also be seen. Some other Rowmanosky stained slides. They are immature red
red cell inclusions can only be appreciated with supravital cells newly released from the marrow sinusoids and
staining (reticulocyte preparations). Heinz bodies are takes about a day or two to mature in the peripheral
denatured haemoglobin (seen in oxidant injury, G6PD circulation in those with intact spleen. Nucleated red
deficiency). Haemoglobin H inclusions are seen in cells are not normally seen in the periphery except in
alpha-thalassemias giving rise to the characteristic ‘golf neonates. Their presence on blood film suggests a