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ﺗﻔﺳﯾر اﺳﻣﯾر ﺧون ﻣﺣﯾطﯽ
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تفسیر اسمیر خون محیطی<br />
RBC<br />
WBC<br />
PLT<br />
Dr. Keramati
بررسي مورفولوژي گلبولھاي قرمز<br />
اندازه:<br />
1- آنیزوسیتوز، ماكروسیت، میكروسیت<br />
رنگ:<br />
2- ھیپوكروم، ھیپركروم، آنیزوكروم، پلي كروم<br />
-3<br />
شكل: پوئیكیلوسیت(اشكال اووالوسیت، قطره اشكي، ھلمت،<br />
اسفروسیت، تارگت، شیستوسیت، اكینوسیت،آكانتوسیت و...)<br />
-4<br />
ساختمانھاي غیر طبیعي داخل ):RBC بازوفیلي منقوط،<br />
سیدروسیت، اجسام ھاول جولي، حلقھ كابوت، مالاریا)
اندازه RBC<br />
• Anisocytosis refers to variation in RBC size<br />
• Micro: Diameter 100<br />
– Megaloblastic<br />
– Non megaloblastic: AA-liver dis-alcholism-RAhypothyroidism-CDA(III-I)
رنگ RBC<br />
• Normochrom<br />
• Hypochrom: decreased MCH<br />
• IDA-thala-ACD-SA- Pb poisoning<br />
• Hyperchrom: increased MCH( Hyperchrom)<br />
• Anisochromia(VAR)<br />
– Dimorphic anemia(hypo&normo)<br />
SA-IDA-transfusion<br />
• Polychromatophilia
Copyright ©2002 American Society of Hematology.
Polychromatophilia results from residual RNA in the cell which gives the classic blue-gray<br />
appearance with standard stains<br />
Copyright ©2004 American Society of Hematology.
poikilocytosisis
Elliptocytes<br />
• Most abundant in hereditary elliptocytosis<br />
• Occasionally assotiated with HA<br />
• In normal blood less than 5%<br />
• IDA<br />
• MMM<br />
• MA<br />
• SCA
Spherocytes<br />
Lack the central pale area or a smaller<br />
eccentric pale area<br />
• Hereditary spherocytosis<br />
• AIHA<br />
• Direct physical (BURN)or chemical<br />
injury
Target cell (Leptocyte)<br />
• Obstructive jaundice<br />
• Postsplenectomy state<br />
• Any hypochromic anemia<br />
especially thalassemia<br />
• Hemoglobin C disease
Schistocyte (cell fragments)<br />
• Indicates hemolysis( DIC, HUS, SEPSIS,TTP)<br />
• Megaloblastic anemia<br />
• Severe burns
Acanthocyte<br />
• Abetalipoproteinemia<br />
(Hereditary,acquired)<br />
• Certain cases of liver<br />
disease
Crenated cell<br />
• Artifact- hyperosmolarity-decreased ATP(PK)-uremia
Tear drop cell
Blister cell<br />
• G6PD<br />
• Unstable Hb
Stomatocyte
ساختمان ھای داخل RBC<br />
• Basophilic stippling<br />
• Howell-jolly body<br />
• Cabot ring<br />
• Pappenheimer body (Sidrocyte)<br />
• Heinz body<br />
• Hb H<br />
• Hb C<br />
• Malarria : ring-Schuffner g. – murrer – zeimmen
Basophilic stippling<br />
• abnormalinstability of RNA<br />
– Fine: increased polychromatophilic<br />
– Coarse: lead poisoning-MA- thalassemia-5PN
Copyright ©2007 American Society of Hematology.
Pappenheimer body (Sidrocyte)<br />
– DDx = BS (P. H. are fewer number&splenectomy)
Howell-jolly body<br />
• Smooth-round-remnant of nuclear chromatin<br />
– Single : MA- HA-spelenectomy<br />
– Multiple: MA-dyserythropoiesis
Cabot ring<br />
• Microtubule<br />
– eight or loop shaped-occasionally double or several concentric<br />
– PA- lead poisoning -dyserythropoiesis
Malarria<br />
Ring - Schuffner g. – murrer – zeimmen
other<br />
• Rouleaux formation<br />
• Agglutination<br />
• NRBC<br />
• Leukoerythroblastic reaction
Rouleaux formation
Agglutination
NRBC and Leukoerythroblastic Reaction<br />
• Metastatic tumors<br />
• MPD<br />
• Leukemia and Lymphoma<br />
• Benign: Hemolysis,<br />
Bleeding, Infection
WBC morphology and Differential WBC<br />
Count<br />
Differential WBC Count<br />
• Neutrophil 50 - 70 %<br />
• Eosinophil 2 - 4 %<br />
• Basophil 0.5 - 1 %<br />
• Lymphocyte 20 - 40 %<br />
• Monocyte 3 - 8 %
Neutrophils
Platelets<br />
• Platelets are not true cells.<br />
• 2-4 µm in diameter<br />
• Round to oval<br />
• Fine purpule granule<br />
– Granulomere<br />
– Hyalomere<br />
• PLT>3 µm & hpogranular are less<br />
than 5% in PBS made at 10-60 min
Platelets<br />
• PLT Count<br />
• Size (MPV, PDW)<br />
• Morphology<br />
• Distribution ( Clumping)
Others<br />
• Artifacts<br />
– Broken cell<br />
– Bare nuclei<br />
– Basket cell<br />
– Contracted cell
Basket and Shadow Cells<br />
لنفوسیتوز آتی پیک<br />
لوسمی لنفوسیتی مزمن<br />
لوسمی حاد<br />
•<br />
•<br />
•
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