Blood smear

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Red blood cells, sickle cell Red blood cells, tear-drop shape Red blood cells, normal Red blood cells, elliptocytosis Red blood cells, spherocytosis Acute lymphocytic leukemia - photomicrograph Red blood cells, multiple sickle cells Malaria, microscopic view of cellular parasites Malaria, photomicrograph of cellular parasites Red blood cells, sickle cells Red blood cells, sickle and pappenheimer Red blood cells, target cells Formed elements of blood

Overview Risks Results

Blood smear

• Normal differential
• Normal appearance of cells

Red cell abnormalities such as size, shape, hypochromia (lack of color), polychromatophilia (multiple colors), rouleaux (nonspecific coating by serum globulins) are determined. Some abnormalities may be graded on a 4 point scale:

• 1+: 25%
• 2+: 50%
• 3+: 75%
• 4+: 100% of cells affected

The presence of target cells may indicate:

• Decreased osmotic fragility
• Liver disease (especially obstructive jaundice)
• Hemoglobinopathies (hemoglobin abnormalities)
• Thalassemia
• Post-splenectomy
• Deficiency in an enzyme called lecithin cholesterol acyl transferase
• Deficiency in iron

• Increased osmotic fragility
• Hereditary spherocytosis
• Immunohemolytic anemia

The presence of elliptocytes may indicate hereditary elliptocytosis.

The presence of schistocytes may indicate:

• Microangiopathic hemolytic anemia
• Disseminated intravascular coagulation (may be due to gram-negative sepsis or malignancy)
• Thrombotic thrombocytopenic purpura (TTP)
• Aortic valve prosthesis (artificial heart valve)
• Hemolytic uremic syndrome (HUS)

• Severe hemolysis
• Leukoerythroblastic anemia (myelophthisis process)
• Myelofibrosis
• Cancer that has spread to bone marrow
• Thalassemia
• Post-splenectomy
• Miliary tuberculosis
• Erythroblastosis fetalis

• Artifact (induced result) from specimen preparation
• Uremia

• Severe liver disease
• Abetalipoproteinemia

• Myelofibrosis
• Leukoerythroblastic anemia
• Thalassemia major
• Severe iron deficiency

• Post-splenectomy
• Sickle cell anemia
• Myelodysplasia

• G6PD deficiency
• Congenital hemolytic anemia
• Unstable hemoglobin variant (unstable form of hemoglobin)
• Alpha thalassemia

The presence of reticulocytes (more than 2% of total red cells; seen with special stain) may indicate hemolytic anemia or hemorrhage.

The presence of basophilic stippling may indicate:

• Myelofibrosis
• Myelophthisic process
• Lead poisoning

The presence of sickle cells may indicate sickle cell anemia.

Additional conditions under which the test may be performed:

• Clinical hemoglobin C
• Hairy cell leukemia
• Non-Hodgkin's lymphoma
• Any known or suspected blood disorder

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