Peripheral Blood Smear

[MudPhud20XX]

So I am really bad at this, can anyone help me out with this? What do you guys see? At least I can say that it's not megaloblastic anemia, right? And no shistocytes, helmet cells....

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[iki4life]

i suck at this stuff too... definetely no helmit cells/ schistocytes so that eliminates hemolysis, thrombosis, embolus or DIC. All I see are a bunch of bilobular nuclei and RBC's lacking central pallor.

 

[MudPhud20XX]

i suck at this stuff too... definetely no helmit cells/ schistocytes so that eliminates hemolysis, thrombosis, embolus or DIC. All I see are a bunch of bilobular nuclei and RBC's lacking central pallor.

good point. yeah clearly not hemolytic type of dz nor DIC. so I thought I was seeing some spherocytes which could indicate hereditary type. I will give some more time for others. Thanks for the feedback!

 

[Transposony]

Take it step by step.
First--you see too many blue cells
Second--look closely at blue cells, they look like blasts (big and bulky looking).
Third- you can see quite a bit of cytoplasm with granules around the nucleus in the blast cells, so most likely myeloblasts (Lymphoblasts have very little cytoplasm and no granules).
Also, you see that these blue cells are in different stages of differentiation.
Red cells look alright except that they seems to be having rouleaux formation (stacking).
So, it looks like a myelobalstic leukemia and certainly not megaloblastic anemia since you don't see hypersegmented neutrophils.

 

[MudPhud20XX]

Take it step by step.
First--you see too many blue cells
Second--look closely at blue cells, they look like blasts (big and bulky looking).
Third- you can see quite a bit of cytoplasm with granules around the nucleus in the blast cells, so most likely myeloblasts (Lymphoblasts have very little cytoplasm and no granules).
Also, you see that these blue cells are in different stages of differentiation.
Red cells look alright except that they seems to be having rouleaux formation (stacking).
So, it looks like a myelobalstic leukemia and certainly not megaloblastic anemia since you don't see hypersegmented neutrophils.

thanks! appreciate it. you're right. this is a blood smear from CML. so as you said, those RBCs are not spherocyte, they are stacked together....

 

[cruCiATE]

If I am not mistaken I will also like to add that CML is the only Leukemia strongly associated with Basophilia.
Basophils are the Smaller (darker) cells with Cytoplasmic granules.

 

[MudPhud20XX]

good point! basophilia in CML!!!

 

[Transposony]

Here is a link to understand Peripheral Blood Smear.

 

[IH8ColdWeath3r]

Here is a link to understand Peripheral Blood Smear.

This is money, and extremely helpful. Thanks for the share.

 

[thehundredthone]

As an addition, those kidney shaped nuclei belong to monocytes, again of myeloid lineage.

 

[Transposony]

Here is a virtual peripheral smear where you can move the slide to see all possible kinds of pathology seen on a peripheral smear.

 

[thehundredthone]

Here is a virtual peripheral smear where you can move the slide to see all possible kinds of pathology seen on a peripheral smear.

Great resource.

Also looking at those monocyte looking cells more closely, they could just as well be (and more likely are) metamyelocytes/band forms. Either way, too many myeloid cells.

 

[Gdl88]

Here is a virtual peripheral smear where you can move the slide to see all possible kinds of pathology seen on a peripheral smear.

thanks