July 2023
Monthly Digital Case Study
July 2023 QSP Slides
Hemoglobinopathies - Part 3
Blood Film Preparation
Quiz
(PDF for print)
July 2023 QSP Slide 6:
Picture 1
Picture 2
Picture 3
FBC Results | |||
| WBC | 5.02 (10^3/mm3) | Reticulocyte | 6.8% |
| RBC | 3.80 (10^6/mm3) | Neutrophils | 30.4% |
| HGB | 15.3 (g/dL) | Lymphocytes | 43.5% |
| HCT | 46.4 (%) | Monocytes | 17.4% |
| MCV | 122 (fL) | Eosinophils | 8.7% |
| MCH | 40.3 (pg) | Total Nucleated RBC | 42 |
| MCHC | 33.0 (g/dL) | ||
| PLT | 247 (10^3/mm3) | ||
Clinical Details: Baby, 1 day old
Slide Information: Anisocytosis (++), Microcytes/Macrocytes (+), Poikilocytosis/ Echinocytes, Erythroblastosis (different stages of maturity observed. NRBC with expelled nuclei/acidophilic NRBC/polychromatophilic NRBC/basophilic NRBC).
In picture 1: a: microcyte/microspherocyte, b: large polychromatic RBC, c: Echinocyte. Picture 2 and 3 show different types of NRBC.
Thalassemia is a hereditary blood disorder in which the body produces an abnormal amount of hemoglobin. Normal adult hemoglobin consists of two α and two β chains. In a healthy individual, there are produced in roughly the same amounts. Thalassemia occurs when production in one of these chains is deficient, resulting in less than the normal amount of hemoglobin being produced. As the two main types of adult hemoglobin are A and B, thalassemia are divided into two main categories, according to the effected globin gene: α-thalassemia and β-thalassemia. Each of these categories have a number of variants which differ in the severity of symptoms they produce. Beta thalassemia major is the most severe type.
Other types include beta thalassemia intermedia, alpha thalassemia major, and hemoglobin H disease.
It's also possible to be a "carrier" of thalassemia, also known as having the thalassemia trait.
Being a beta thalassemia carrier will not generally cause any health problems but increases the risk of having children with thalassemia.
This disorder causes large amounts of red blood cells to be destroyed, which leads to anemia.
Thalassemia occurs across the globe, but is most prevalent among the following populations: Beta Thalassemia is most prevalent in populations that border the Mediterranean sea: Italy, Sicily, Sardinia, Greece, Lebanon, Turkey and Armenia. Alpha Thalassemia is more common in the far east, such as China, India, and Thailand.
Both Alpha and Beta thalassemia's are common in certain African populations.
Look out for our next newsletter on symptoms, testing and treatment of thalassemia.
Paramount to the accuracy and precision of blood film morphology is a well-made and stained blood film. Traditionally blood films were made manually (wedge-spread) which appears an easy procedure but in fact, it takes a lot of practice to achieve uniform length and thickness. A drop of blood is placed near one end of the slide in a central position. The spreader (often a glass slide with a corner cut off) is placed at the front of the drop at an angle of about 25 – 30O and then drawn back into the blood. Blood is allowed to run along the face of the spreader until the distribution is even. The spreader is then moved away from the drop in a smooth steady motion.
The blood film should end about 2/3 of the way along the slide and have a slightly curved leading almost straight tail (see examples below). An experienced operator will automatically take into the account the Hct of the blood sample and if the Hct is very high or low the angle and speed of the spreader to achieve a blood film of the appropriate length and density is altered.
1) Too large drop of blood, not allowing enough time for the blood to reach both edges of the spreader.
2) Too fast spreading? Low Hct, therefore the speed and angle should be amended.
3) Not allowing enough time for blood to reach both edges of the spreader, speed too slow.
Making blood films is a time-consuming process and due to operator experience the quality of the blood film and therefore distribution of cells within the smear can be variable.
Can you name the white cell in the slide image below?
A) Blast Cell
B) Eosinophil
C) Basophil
Basophils are the least common of all the white cells and are easily identified due to the presence of numerous large deeply stained granules which often obscure the bi-lobed nucleus.
Bibliography
https://medlineplus.gov/lab-tests/hemoglobin-electrophoresis/
Essential Haematology, A.V .Hoffbrand & J.E.Pettit
https://www.mayoclinic.org/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1390791/
Do you have any questions or requests? Use this form to contact our specialists.
