實用血液抹片

血液抹片判讀的注意事項
 為何而拉 ?
 大小
 顏色
 內容物
 RBC
 WBC
 Platelet
為何而拉 > 要先有診斷 !!
 Cytopenia
 MDS: hypersegment, hypolobulation, blast
 Nutrition deficiency: hypersegment, microcystic, hypochromatic
 Cytosis
 MPN: tear drop
 Leukemia: blast
 Morphology
 Leukemia: blast, immature cell
 MAHA: fragment RBC
 Congenital RBC disease: sickle cell, sphrenocyte
VS
紅血球篇
Erythroblast/nucleated RBC
 Immature RBC in PB
 Large blood loss
 Destruction of bone marrow
barrier
白血球篇
Lymphocyte
 High N/C ratio
 Dense nuclear
 Size near RBC-> good reference
for RBC size mearsurement
Metamylocyte
 Immature cell

 Reactive of infection,
inflammation
 G-CSF effect
 Myeloid neoplasm: CML
Promylocyte
 Immature cell with nucleolus

 Severe bone marrow barrier

dysfunction
 APL !!!
 Leukemia
Monocytes
 Large size
 Irregular nuclear
 Mononuclear

 Reactive change
 Special disease
Blast
 Immature cell with nucleolus

 Leukemia
 MDS
 PMF
Reactive lymphocyte
 Reactive for infection or
inflammation
 No nucleolus

 Viral infection
 Autoimmune disease
Blast? Reactive lymphocyte?
Pelgeroid cell(hypolobulation)
 Dysplasia picture

 MDS!!!
Hypersegment WBC
 DNA instability of WBC

 Folate, B12 deficiency

 MDS
Toxic granular/Auer rod/Dohle bodies
 Granular in WBC

 Aucte infection
 Blast > APL
 G-CSF effect
血小板篇
Gaint platelet
 Fresh platelet

 Large platelet consumption

 ITP
 TTP
Clumping
 False thrombocytopenia
Take home message
 要知道想看什麼 finding 才有拉片的價值
 要配合 CBC 本身的數值去看片子
 重要的紅血球 finding: fragment RBC, nucleated RBC
 重要的白血球 finding: hyper or hypo segment, immature cell with
nucleolus
 重要的血小板 finding: 其實沒有…
小試身手
 106 年內專

CBC:
WBC: 24000
HB: 8.2
Plt: 12000

CMMoL
MDS+MPN
 106 年內專

CBC:
HB: 6.3
Reti: 3.5%
Bil(T/D): 3.4/0.7

Thalassemia
 107 年內專

CBC:
WBC: 130810
HB: 10.5
Plt: 47000

CML
 107 年內專

CBC:
WBC: 8500
HB: 7.5
Plt: 11000
Reti: 5.4%
Bil(T/D): 3.1/0.7
Con’s change
LDH: 1350
Crea: 1.1
PT/aPTT: normal

MAHA(TTP)
108 年內專

APL
感謝可愛的工作細胞們 ~

Thank you!