DESKTOP READY RECKONER FOR THE PRACTICING PAEDIATRICIAN TO IDENTIFY CERTAIN BASIC CELLS IN A PERIPHERAL SMEAR & URINE

SEDIMENTS

Prepared by Dr.S.R.Srinivasa Kannan,MD.Path, Vivek Laboratories, 253,K-11,K.P.Road, Nagercoil-3. 629003 . e mail: srinivasakannan@yahoo.com

 This is not an exhaustive reference.

This is only a short introduction to the exciting field of Clinical Microscopy

Note
Areas for morphological assessment should be large enough that at least 100 WBCs can be identified in samples with a WBC count within the reference interval for a specific individual. In a wedge blood film preparation, the best area is where red blood cells barely touch each other. Cells should not be damaged by the preparation or staining procedure or by excessive shear forces for microscopy In a large blood film preparations; large cells such as monocytes may be pushed to the periphery and the feathered edge of the blood film.

Good & Bad smear

Smooth & Uniform staining Irregular smear, Oil droplets

Examine
Platelets: Examine the whole smear

RBCs: Where cells are just touching each other

WBCs: in zig zag fashion

Normocytic Normochromic: Equal in size to the nucleus of lymphocytes or slightly larger with small central pale area

Macrocytic: Larger than the normoytes. Always normochromic

Microcyte: Smaller than the nucleus of the small lymphocyte. Always hypochromic-marked central pallor

Spherocytes:Small cells with no central pallor

Elliptocyte/Ovalocyte : Abnormal congenital oval forms

Stomatocytes : Abnormal congenital forms with a central mouth like slit.

Target Cells: Seen in Liver disorders and thalassemias

Sickle cells:

Sickling at hypoxic conditions. HbS.

Drying of slide can pull the plasma and produce sickle shaped artifacts which is of variable size and the pulling effect will be obvious by the clearing in the surrounding areas

 Echinocyte: Many short regular projections. Usually EDTA effect.

Acanthocyte: Irregular cytoplasmic spicules of variable length Irregularly disposed over the surface. (red cell Membrane abnormality

MP: P.falciparum

Basophilic stipplings:
Numerous basophilic granules. Occurs in Thalassemias, lead poisoning & liver disease

Platelet Mimicking MP

Water Artifact: Cells swollen and partly dehemoglobinised

Reticulocytes: seen with New methylene blue Normoblasts: Normoblasts-Mimics lymphocytes. Note abundance of cytoplasm, irregular borders, Centrally placed nuclei

Stain particles: Mimics platelets. Bluish in color

Platelets: Found as clumps and as single platelets

Polymorph: Two to many lobes. Cytoplasm shows azurophilic (grey)

Granules.

Eosinophil has eosin granules Toxic granules: Seen in Septicaemia

Hypersegmented Neutrophils: Seen in Megaloblastic Anemia

Eosinophil

Polymorph

Basophil Monocytes

 Myelocyte: Mimicking monocyte. Bean shaped nucleus and granules in cytoplasm

 Promyelocyte: Comparable to myelocyte but in addition has nucleoli.

 Myeloblast : Similar to promyelocyte but without granules. Cytoplasm May show eosin coloured short rods-Auer rods . Nucleoli>4

Lymphoblast: Large cell. Cytoplasm is scanty. 1-2 nucleoli. No granules

Storage artifacts: WBCs show fragmentation of nuclei and can mimic normoblats.

 Urine Sediments

iQ200 Automated Urine Microscopy Analyzer

Hyaline cast Smooth borders, almost transparent

Border not regular. Cells and fragments seen

Degenerated cellular cast is granular cast

Cellular cast + yeast cells

Refractile bodies with cut edges

Ca oxalate

Triple phosphate

tyrosine

cholesterol

cystine

Uric acid

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