Prepared by:

Mr:Mahmoud El-Hindi

Miss:Afnan Abdelmoneim

LAB 12:BLOOD &

BONE MARROW SMEARS

OBJECTIVES

1. Handling and evaluation of blood &

bone marrow smears.

2. Understand methods for detection

INTRODUCTION

• A peripheral blood smear (or blood film):is

a thin layer of blood smeared on a glass

microscope slide and then stained in such a way

as to allow the various blood cells to be

examined microscopically.

• Blood films are examined in the investigation of

hematological (blood) disorders and are routinely

employed to look for blood parasites, such as

those of malaria and filariasis.

PREPARATION• Blood films are made by placing a drop of

blood on one end of a slide.

• Using a spreader slide to disperse the blood

over the slide's length.

• The aim is to get a region; called a

monolayer.

• where the cells are spaced far enough apart

to be counted and differentiated.

CONT..

• The slide is left to air dry, after which the

blood is fixed to the slide by immersing it

briefly in methanol.

• The fixative is essential for good staining

and presentation of cellular detail.

• After fixation, the slide is stained to

distinguish the cells from each other.

CONT..

Wright-Giemsa combination stain is also a

popular choice.

These stains allow for the detection of white

blood cell, red blood cell, and platelet

abnormalities. Hematopathologists often use

other specialized stains to aid in the

differential diagnosis of blood disorders.

CONT..

After staining, the monolayer is viewed

under a microscope using magnification

up to 1000x. Individual cells are examined

and their morphology is characterized and

recorded.

THERE ARE THREE MAIN CELLS WITHIN THE BLOOD THAT THE TEST FOCUSES ON:

• red cells (which carry oxygen throughout

the body)

• white cells (which function as part of the

body’s immune system).

• platelets (which are important for blood

clotting)

CONT..

Abnormalities in the shape, size, and

number of the red blood cells can affect

how oxygen travels throughout the

blood. These abnormalities are often

caused by a mineral or vitamin

deficiency, but can be caused by

abnormal proteins such as in sickle cell

anemia.

CONT..

White blood cells are an integral part of the

body’s immune system, a network of

tissues and cells that function to keep the

body safe from invading microorganisms

and eliminate existing infection. Disorders

affecting these cells can often result in the

body’s inability to eliminate or control

infections.

CONT..

Platelet disorders affect blood clotting

and are often the result of the body

producing the wrong amount of platelets

needed (either too many or too few).

OVERVIEW

Evaluation of complete blood count data

and examination of a peripheral blood

smear are the first diagnostic steps in

defining a hematologic disease.

The information gathered from examination

of these data may dictate subsequent

diagnostic tests and procedures.

CONT..

The reliability of the information obtained

from the smear depends to a considerable

extent on the quality of the preparation.

Properly spread films are essential to

accurate work. The slides must be

perfectly clean and free of grease.

DISORDERS

Characteristic red blood cell abnormalities

are anemia, sickle cell anemia and

spherocytosis. Sometimes the microscopic

investigation of the red cells can be

essential to the diagnosis of life-

threatening disease (e.g. TTP).

CONT..

White blood cells are classified according

to their propensity to stain with particular

substances, the shape of the nuclei and

the granular inclusions.

BLOOD DISORDERS AFFECTING

RED BLOOD CELLS

Anemia : People with anemia have a low

number of red blood cells.

Mild anemia often causes no symptoms.

More severe anemia can cause fatigue,

pale skin, and shortness of breath with

exertion

CONT..

Aplastic anemia: In people with aplastic

anemia, the bone marrow does not produce

enough blood cells, including red blood cells.

• A viral infection, drug side effect, or an

autoimmune condition can cause aplastic

anemia.

• Medications, blood transfusions, and even a

bone marrow transplant, may be required to

treat aplastic anemia

CONT..

Sickle cell anemia: A genetic condition

that affects mostly people .

In sickle cell anemia, the red blood cells

are sticky and stiff. They can block blood

flow. Severe pain and organ damage can

occur.

CONT..

Polycythemia vera: The body produces

too many blood cells, from an unknown

cause.

The excess red blood cells usually create

no problems but may cause blood clots in

some people.

CONT..

Malaria: A mosquito's bite transmits a

parasite into a person's blood, where it

infects red blood cells.

• Periodically, the red blood cells rupture,

causing fever, chills, and organ damage.

BONE MARROW ASPIRATE SMEARS

INTRODUCTION

Bone marrow examination refers to the

pathologic analysis of samples of bone marrow

obtained by bone marrow biopsy (often called a

trephine biopsy) and bone marrow aspiration.

Bone marrow examination is used in the

diagnosis of a number of conditions, including

leukemia, multiple myeloma, lymphoma,

anemia, and pancytopenia

CONT..

The bone marrow produces the cellular elements

of the blood, including platelets, red blood cells

and white blood cells.

While much information can be gleaned by testing

the blood itself (drawn from a vein by phlebotomy),

it is sometimes necessary to examine the source of

the blood cells in the bone marrow to obtain more

information on hematopoiesis; this is the role of

bone marrow aspiration and biopsy.

NORMAL SMEAR

A WRIGHT'S STAINED BONE MARROW ASPIRATE

SMEAR OF PATIENT WITH PRECURSOR B-CELL

ACUTE LYMPHOBLASTIC LEUKEMIA .

Multiple myeloma

Multiple myeloma is a malignant, clonal disorder

of plasma cells that originates in the bone

marrow.

• It’s a relatively common disorder, accounting

for 1% of all malignancies and 10% of all

hematologic malignancies in adults.

• Patients present with painful, lytic lesions of the

bones, recurrent and persistent infections,

weakness, renal failure, and hypercalcemia.

CONT..

Patients with myeloma have a monoclonal

proliferation of plasma cells in the bone

marrow, meaning that there are a ton of

malignant plasma cells that all originated

from the same initial cell.