At a Glance

Why Get Tested?

To evaluate your red blood cells (RBCs), white claret cells (WBCs), and platelets, to distinguish between the dissimilar types of WBCs, and to determine their relative percentages in the blood; to help detect, diagnose, and/or monitor a range of deficiencies, diseases, and disorders involving claret jail cell product, function, and lifespan

When To Get Tested?

When complete claret count (CBC) and/or automatic WBC differential results are abnormal or when you have signs and symptoms that a health care practitioner suspects are due to a condition affecting your blood cells

Sample Required?

A claret sample drawn from a vein in your arm or by pricking a finger or, in the instance of an infant, a heelstick

Test Preparation Needed?

None

What is beingness tested?

A blood smear is a drop of claret spread thinly onto a glass slide that is then treated with a special stain and the claret cells on the slide are examined and evaluated. Traditionally, trained laboratorians accept examined blood smears manually using a microscope. More than recently, automatic digital systems have go available to assistance clarify blood smears more efficiently.

A blood smear is a snapshot of the cells that are present in the blood at the time the sample is obtained. The blood smear allows for the evaluation of these cells:

  • White blood cells (WBCs, leukocytes) — help fight infections or participate in immune responses
  • Red blood cells (RBCs, erythrocytes) — behave oxygen to tissues
  • Platelets (thrombocytes) — small cell fragments that are vital to proper blood clotting

These prison cell populations are produced and mainly mature in the bone marrow and are eventually released into the bloodstream as needed. The number and blazon of each cell nowadays in the blood is dynamic but is generally maintained by the trunk inside specific ranges.

The drop of blood on the slide used for a claret smear contains millions of RBCs, thousands of WBCs, and hundreds of thousands of platelets. A blood smear examination:

  • Compares the WBCs' size, shape, and full general advent to the established appearance of "normal" cells. It also determines the five unlike types of WBCs and their relative percentages (manual WBC differential).
  • Evaluates the size, shape, and color (indicators of hemoglobin content) of the RBCs (RBC morphology)
  • Estimates the number of platelets nowadays

A multifariousness of diseases and conditions can bear upon the number and appearance of blood cells. Examination of the claret smear can be used to support findings from other tests and examinations. For example, RBCs that appear smaller and paler than normal may support other results that indicate a type of anemia. Similarly, the presence of WBCs that are not fully mature may add to information from other tests to help make a diagnosis of infection, malignancy, or other conditions.

Mutual Questions

How is the blood smear used?

A blood smear is often used as a follow-up test to abnormal results on a complete blood count (CBC) to evaluate the different types of blood cells. It may be used to help diagnose and/or monitor numerous weather that affect claret jail cell populations.

At one fourth dimension, a claret smear was prepared on nearly everyone who had a CBC. With the evolution of more sophisticated, automated blood prison cell counting instruments, information technology has now become routine to provide an automated differential. However, if the results from an automatic prison cell count and/or differential signal the presence of immature, atypical, or abnormal white blood cells (WBCs), red blood cells (RBCs), and/or platelets or if there is reason to doubtable that aberrant cells are present, then a claret smear may be performed.

A claret smear is ofttimes used to categorize and/or place weather condition that bear on one or more type of blood cells and to monitor individuals undergoing treatment for these atmospheric condition. There are many diseases, disorders, and deficiencies that can bear on the number and type of blood cells produced, their part, and their lifespan. Examples include anemia, myeloproliferative neoplasms, bone marrow disorders, and leukemia.

Usually, only normal, mature or nearly mature cells are released into the bloodstream, but sure circumstances can induce the bone marrow to release immature and/or aberrant cells into the circulation. When a pregnant number or blazon of abnormal cells are nowadays, it tin suggest a disease or status and prompt a health care practitioner to practise further testing.

When is it ordered?

The blood smear is primarily ordered equally a follow-up test when a CBC with differential, performed with an automated blood cell counter, indicates the presence of atypical, abnormal, or immature cells. It may likewise exist performed when a person has signs and symptoms that suggest a status affecting claret cell production or lifespan.

Examples of signs and symptoms that may indicate ane of these blood disorders include:

  • Weakness, fatigue
  • Pale complexion
  • Unexplained jaundice, which is yellowing of the skin and the whites of the eyes
  • Fever
  • Excessive haemorrhage episodes, easy bruising, or frequent nose bleeds
  • Enlargement of the spleen
  • Os hurting

A blood smear may also exist ordered on a regular basis when a person is existence treated or monitored for a blood prison cell-related illness.

What does the test result mean?

Findings from a blood smear evaluation are not e'er diagnostic in themselves and more often betoken the possibility or presence of an underlying condition, its severity, and the demand for farther diagnostic testing. The results are taken into consideration with the results of the CBC and other laboratory tests as well as the tested person'due south clinical signs and symptoms.

The results of a blood smear typically include a clarification of the appearance of the red blood cells, white blood cells, and platelets as well as any abnormalities that may exist seen on the slide.

Red Blood Cells (RBCs)
Normal, mature red blood cells are uniform in size (seven-8 µm in diameter) and practise non have a nucleus equally most other cells do. They are round and flattened like a donut with a depression in the middle instead of a hole (biconcave). Due to the hemoglobin inside the RBCs, they appear pink to red in color with a pale center after staining the claret smear. When the appearance of RBCs (RBC morphology) is normal, it is ofttimes reported every bit normochromic (normal color) and normocytic (normal size).

While non every RBC volition be perfect, any significant number of cells that are different in shape or size may indicate the presence of disease. Some examples of conditions that can affect red blood cells include:

  • Anemia
  • Hemoglobin variants including sickle cell anemia and thalassemia
  • Leukemia
  • Myeloproliferative or myelodysplastic neoplasms
  • Bone marrow disorders

At that place may exist ane or more RBC irregularities seen on a blood smear. Ii examples include:

  • Anisocytosis — variable sizes of ruby-red blood cells may bespeak anemia; RBCs smaller than normal are referred to as microcytes and RBCs larger than normal are called macrocytes.
  • Poikilocytosis — various shapes of cherry-red cells; these may include burr cells (echinocytes), acanthocytes, elliptocytes, rouleaux, sickle cells, target cells, teardrop cells, and schistocytes (ruddy cell fragments, helmet cells).
  • Anisopoikilocytosis — variability in both RBC size and shape

Come across the section below for Details on Ruddy Blood Cell Irregularities.

White Blood Cells (WBCs)
As part of a blood smear evaluation, a manual WBC differential may be performed. Typically, at least 100 WBCs are evaluated and categorized co-ordinate to type. The percentage of each type is calculated. In improver, the advent (morphology) and stage of development of the WBCs are noted. White blood cells accept a nucleus surrounded by cytoplasm. All WBCs are derived from bone marrow stem cells. In the os marrow, they differentiate into two groups: myeloid and lymphoid cells. They mature into v singled-out types of WBCs.

Those with granules in their cytoplasm are also called granulocytes (they are of myeloid lineage) and include:

  • Neutrophils (ten-18 µm) are cells that have cytoplasm with pinkish or purple granules. They comprise the majority of WBCs in a healthy adult. They are involved in the defence force against infections.
  • Eosinophils (ten-15 µm) are easily recognized in stained smears with their large, ruby-orange granules. Generally low in number (1-3%), they most often increase in number in individuals with allergies and parasitic infections.
  • Basophils (x-15 µm) take large, imperial-black granules and are the least often seen type of WBC (one%).

The not-granulocytes include:

  • Monocytes (which are as well of myeloid lineage) are usually the largest of the WBCs (12-20 µm) and are often referred to as scavenger cells (phagocytes). They can ingest particles such as cellular debris, bacteria, or other insoluble particles.
  • Lymphocytes are often smaller in size (10-12 µm) and usually accept a small corporeality of cytoplasm and oftentimes a smoothen, round nucleus although some are larger and tin contain a greater amount of cytoplasm. They usually stand for the about common type of WBC in younger children. One type of lymphocyte, the B-cell, is responsible for the product of antibodies (immunoglobulins).

Numerous diseases and atmospheric condition can touch on the absolute or relative number of WBCs and their appearance on a blood smear. Examples of some of the conditions include:

  • Infections and/or inflammation — tin increase certain types of WBCs
  • Bone marrow disorders — depending on the condition, may increase or subtract absolute and relative numbers of WBCs
  • Allergies — may touch on the number of eosinophils
  • Leukemia, myelodysplastic syndrome or myeloproliferative tumour — immature white blood cells such as blasts may exist seen on the blood smear; blasts are normally found in the bone marrow where WBCs are produced and mature before being released into the blood. If blasts are seen on a blood smear, they may indicate a serious bone marrow disease. They can too be seen in other scenarios, such every bit when the bone marrow is recovering or regenerating from chemotherapy, or, as another example, stimulated by a medication prior to stem cell collection.

Run across the section below for more than Details on White Blood Cells.

Platelets
These are cell fragments that develop from large os marrow cells chosen megakaryocytes. Upon release from the bone marrow, they appear every bit fragments in the peripheral blood. When in that location is blood vessel injury or other bleeding, the platelets become activated and begin to clump together to grade aggregates, which is the first of a claret clot.

There must exist a sufficient number of platelets to control bleeding. If at that place are too few, or if they don't function properly, the power to form a clot becomes impaired and can be a life-threatening situation. In some people, too many platelets may be produced, which may effect in interferences with the menstruum of blood, increasing a person'south risk of developing a blood clot. These same people may also experience bleeding because many of the extra platelets may be dysfunctional even though they announced normal.

A platelet count is ordinarily part of a CBC. An abnormally depression number or loftier number of platelets may be further evaluated past preparing a blood smear to directly visualize any anomalies in shape or size. For instance, big platelets or behemothic platelets may be seen as the bone marrow tries to compensate for a low platelet count, merely they can as well exist seen in myeloproliferative neoplasms, or immune thrombocytopenia, a condition in which the immune organization inappropriately produces antibodies directed against platelets.

Is at that place anything else I should know?

Blood counts and morphology tin can also be affected during times of affliction or stress, and after transfusion.

Findings on a claret smear that are abnormal are typically referred to a pathologist, often ane with extensive experience in the study of blood (hematology), for further review and interpretation. Depending on the results, follow-up testing involving other bloodwork or even examination of a bone marrow aspirate and biopsy may be required for a diagnosis.

Although uncommonly used for this purpose in the U.South., blood smears may be used to aid diagnose malaria, a affliction acquired by a blood parasite. The parasite may be seen when a blood smear is examined under a microscope. Malaria is normally only seen in travelers returning from areas where the parasite is more common (endemic).

Why hasn't the automated claret prison cell counter totally replaced the blood smear?

It has on a routine basis, only the automated blood cell counter commonly evaluates the scarlet blood cells (RBCs), white blood cells (WBCs), and platelets based on their shape, size, and electrical or photometric properties. In that location can be some variation in each prison cell type and numbers the torso produces. Use of an automated instrument can ofttimes identify the presence of abnormal cells but lacks the ability to definitively subclassify them. Cell fragments and platelet clumps, particularly if they are big in size, tin can be mistakenly counted as WBCs, thus falsely elevating a white jail cell count. A laboratorian tin can run across these abnormalities on a blood smear and has been trained to identify and classify them appropriately.

Traditionally, claret smear review/interpretation has been done manually using a microscope, which is time-consuming. Automated digital morphology systems are now available to assist analyze blood smears more efficiently.

If a drop of claret on a slide contains millions of RBCs, thousands of WBCs, and hundreds of thousands of platelets, how can the laboratorian see individual cells?

A specific technique is used to spread the drop of blood out across a glass slide into a "thumbprint" shape. Along the edges of this thumbprint the cells are only a single layer thick. This allows the cells in this surface area to be individually counted and evaluated nether the microscope.

Details on Reddish Blood Jail cell Irregularities (RBC morphology)

Size

  • Anisocytosis: this is a variation in size of RBCs; it may exist an indication of anemia
  • Macrocytosis: large RBCs that may be due to a vitamin B12 or folate deficiency. They are seen in megaloblastic anemia (east.yard., pernicious anemia), chronic alcoholism, liver illness, thyroid disease, and myelodysplastic syndrome.
  • Microcytosis: this is the presence of pocket-sized RBCs that is commonly due to an iron deficiency anemia or to an inherited disorder such as thalassemia.

Shape

  • Poikilocytosis is a variation in the shape of RBCs and may include several different abnormalities at the same time.
  • Acanthocytes (spur or spiculated cells): irregular shaped cells with 5-ten spicules; may be present in the blood of people who have had their spleen removed (splenectomy) or with liver disease. They are also present in an inherited disorder called abetalipoproteineimia.
  • Echinocytes (burr or crenated): may have 10-30 blunt projections and oft are seen in people with renal failure; may exist an artifact – something caused during sample preparation.
  • Elliptocytes (ovalocyte): elliptical-shaped RBCs seen in hereditary elliptocytosis and various anemias, myelofibrosis.
  • Fragmented cells (schistocytes, helmet cells): fragmented RBCs of various shapes that may be seen in people with disseminated intravascular coagulation (DIC), hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, or a vascular artificial device (prosthesis) such as a mechanical eye valve.
  • Rouleaux: RBCs that appear as a stack of coins and are seen in people with multiple myeloma or Waldenstrom macroglobulinemia considering of increased serum proteins.
  • Sickle cells: crescent-shaped RBCs that are characteristic of sickle cell anemia.
  • Target cells:RBCs that resemble a bull's-eye; commonly seen in people with aberrant inherited forms of hemoglobin (hemoglobinopathies), thalassemia, diverse anemias and liver disease.
  • Teardrop cells (dacrocytes): RBCs that resemble a teardrop; often seen in people with myelofibrosis and thalassemia.
  • Spherocytes: sphere-shaped RBCs that are often present in immune hemolytic anemia or hereditary spherocytosis.

Color

  • Hypochromia/hypochromasia: this may be seen in a diverseness of disorders, including thalassemia and iron deficiency. The RBC is stake in colour due to bereft hemoglobin and contains a large, hollow center (central pallor) of the prison cell.
  • Hyperchromia/hyperchromasia: the RBC is darker in color than normal due to a greater than normal concentration of hemoglobin within the prison cell; this may be due to dehydration or presence of spherocytes.
  • Polychromasia: blue-staining RBCs reflecting increased RNA content, indicating that they are immature due to early release from the bone marrow.

Abnormal structures within the cerise blood cell

  • Nucleated RBCs (NRBC, normoblasts): an immature form of RBCs seen when at that place is increased demand for RBCs to be released by the bone marrow, or when at that place is marrow involvement by fibrosis or tumor; may be seen in astringent anemia, myelofibrosis, thalassemia, miliary tuberculosis, cancers that involve the bone marrow, and in chronic low oxygen levels (hypoxemia). Nucleated RBCs can be normal in infants for the first two or three days afterward birth.
  • Reticulocytes: these are young RBCs that are unremarkably a blue-staining (polychromatic) color. A few of these young red blood cells are normal in the circulation, just they may be nowadays in elevated numbers with acute claret loss, hypoxia, RBC destruction, sickle prison cell disease, glucose-6-phosphate. dehydrogenase (G6PD) deficiency, and autoimmune hemolytic anemia.
  • Siderocyte, sideroblast, ring sideroblast: When RBCs are stained with Prussian blue dye, atomic number 26 granules may be seen. Sideroblasts are immature siderocytes and may actually class a ring pattern indicative of sideroblastic anemia.
  • Basophilic stippling (punctate basophilia) is night blue dots within the RBC; due to abnormal aggregation of ribosomes and polyribosomes and may be present in heavy metal intoxication (such equally lead), thalassemia and many other anemias.
  • Heinz bodies: large inclusion bodies (granules) in the RBCs when stained with a supravital stain similar crystal violet; ofttimes seen in the setting of an enzyme (G6PD) deficiency, drug-induced hemolysis, or unstable hemoglobin disease.
  • Howell-Jolly bodies (pocket-sized, circular remnants of nuclear Dna inside prison cell): present in sickle cell anemia, hemolytic or megaloblastic anemias, and may be seen later on a splenectomy.
  • Cabot band: uncommon threadlike inclusions that course a loop or figure-of-viii structure within the RBC; may be seen in a diversity of anemias.
  • Malarial parasites: in people with malaria, these parasites live inside RBCs and may be visible on a claret smear. This is not a routine finding; these parasites are usually establish in those who live in or have traveled to areas where the disease is owned.

Details on White Blood Cells

Neutrophils

NEUTROPHILS (also called segmented neutrophils, segs, polymorphonuclear cells, polys, or PMNs) are virtually 12 microns in diameter and their function is to engulf and destroy invading organisms. They ordinarily brand up about 50-70% of the full WBC count in the claret of older children and adults and may accept two to five nuclear lobes connected by a thin strand of nuclear material. This type of WBC may exist seen in greater numbers during infections, malignancies, or farthermost stress situations. The cytoplasm of neutrophils is pale and oftentimes contains small pink to purple granules. These granules (specific granules and azurophilic granules) contain certain enzymes and proteins that neutralize or destroy microbes. Bands are young neutrophils with a U-shaped nucleus.

Anomalies of neutrophils may include:

  • Toxic granulation: big dark bluish granules in the cytoplasm, associated with severe infection, burns, trauma, and One thousand-CSF colony stimulating factor therapy; oft reflects accelerated neutrophil maturation.
  • Vacuolization: vacuoles appear equally holes in the cytoplasm and are ofttimes plant in association with toxic granulation simply can also be a degenerative feature seen when the blood is stored for a prolonged catamenia of time before preparing the blood smear.
  • Döhle bodies: irregular grayish or blueish inclusions in the peripheral cytoplasm of neutrophils; they are denatured aggregates of gratuitous ribosomes or rough endoplasmic reticulum that are often seen in association with toxic granules and vacuoles. They may be nowadays in clan with infections, burns, trauma, or with exposure to cytotoxic agents (i.e., chemotherapy). They may also be seen later cytokine stimulation (e.g., K-CSF) or during a normal pregnancy.
  • Auer rods: unique, pinkish or cherry rod-shaped inclusions that are seen in very immature myeloid cells ("blasts") or rarely more mature neutrophils in people with acute myeloid leukemia or high-grade myelodysplastic syndrome.
  • Bands –increased numbers: slightly young neutrophils are normal in the circulation in small numbers, but if there is a pct increase of them, there is said to be a "left shift." This may happen when an acute infection stimulates increased neutrophil production, causing the bone marrow to prematurely release some WBCs before they have matured to the neutrophil phase. Other immature forms that may sometimes be seen on a blood smear include myelocyte and metamyelocyte or even promyelocyte and myeloblast.
  • Hypersegmentation: neutrophils with six or more nuclear segments; this is mainly associated with vitamin B12 and folate deficiency and myelodysplasia but can too be seen with alcoholism and rarely as a hereditary condition.
  • Pelger-Huët bibelot: hereditary bibelot where neutrophils appear with fewer than two lobes; the nucleus is frequently in the shape of a peanut or dumbbell, or may consist of 2 lobes connected with an obvious filament. They may also appear with certain immunosuppressant drugs or in certain affliction states such equally myelodysplasia and is referred to a "pseudo-Pelger-Huët anomaly".
  • Alder-Reilly granules: large, nighttime leukocyte granules that stain purple; they suggest mucopolysaccharidosis (an inherited enzyme deficiency disorder, examples being Hurler's and Hunter's syndromes).
  • Chédiak-Higashi granules: an inherited anomaly characterized past the presence of big red, blue, or greenish granules that may be establish in granulocytes, lymphocytes, and monocytes. People with this syndrome may have oculocutaneous albinism equally well as a compromised immune system and photophobia.

Lymphocytes

Lymphocytes are relatively small (7-10 µm) and circular in shape. The nucleus is by and large big in relation to the amount of cytoplasm. The cytoplasm is pale blue and normally only a minor proportion of lymphocytes has any granules. The nucleus of most lymphocytes is smooth in appearance and is dark bluish.

There are ii major types of lymphocytes, B jail cell and T cell, simply they cannot be distinguished when viewed under the microscope using standard staining techniques. B cells tin can exist differentiated from T cells using specific fluorescent-labeled antibody stains in conjunction with a special musical instrument called a period cytometer. B cells create specific antibodies while T cells can activate B cells equally well as recognize and destroy invading organisms. Lymphocytes normally brand up most 20% to twoscore% of the total WBC count in adults and a college proportion in infants and young children.

  • Reactive lymphocyte (atypical lymphocyte, activated lymphocyte): these cells are large lymphocytes that contain a greater amount of cytoplasm and tin vary in size and shape. Often a feature bluish tinge of cytoplasm is seen where the jail cell abuts with surrounding RBCs. Increased numbers of atypical lymphocytes are found in viral illnesses such as infectious mononucleosis.
  • Hairy cells: these lymphocytes have tiny projections that brand them announced hairy under the microscope; they are constitute in hairy cell leukemia.

Eosinophils

Eosinophils take two or three lobes to their nucleus and contain characteristic cherry-red/orangish granules in their cytoplasm. They are most ofttimes involved in allergic responses and parasitic infections. Ordinarily but about 1-four% of WBCs in the blood are eosinophils.

Monocytes

Monocytes are the largest in size of the WBCs and incorporate less than six% in normal blood. They are characterized past their abundant blue-gray cytoplasm that is irregular in shape and have a folded nucleus. The main function of monocytes is to ingest microbes and respond to infection and inflammation past releasing certain proteins (monokines) that can inactivate leaner. When stimulated by cytokines, monocytes can motion out of the claret and go tissue macrophages.

Basophils

Basophils take a multi-lobed nucleus and have many dark blue granules (which contain histamines) in their cytoplasm. Only well-nigh 1% of WBCs are basophils. A sight tiptop in number may be seen during an allergic response, ulcerative colitis, chronic sinusitis, chickenpox, or after immunizations. A meaning increment is common in chronic myeloid leukemia.

Wellness Professionals – LOINC

Logo for LOINC from RegenstriefLOINC Observation Identifiers Names and Codes (LOINC®) is the international standard for identifying health measurements, observations, and documents. It provides a mutual language to unambiguously identify things you can measure or observe that enables the exchange and aggregation of clinical results for care delivery, outcomes management, and research. Learn More.

Listed in the table below are the LOINC with links to the LOINC particular pages. Please note when yous click on the hyperlinked code, yous are leaving Testing.com and accessing Loinc.org.

LOINC LOINC Brandish Name
710-4 Claret smear finding positive LM Nom (Bld)
5909-7 Blood smear finding LM Nom (Bld)
58445-8 Transmission differential comment Nar (Bld) [Interp]
50957-0 Manual differential performed Ql (Bld)
48705-eight WBC+Platelets Nom (Bld)
79427-ane Platelets LM.HPF (Bld) [#/Surface area]
9317-ix Platelets LM Ql (Bld)
6742-one RBC morphology finding Nom (Bld)
53974-2 Erythrocyte morphology LM Nar (Urine sed) [Interp]
18225-iii RBC shape Nom (Bld)
18226-1 RBC size Nom (Bld)

Related Content

View Sources

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