Peripheral Blood Smear (PBS): A Quick Review
Definition and Overview:
A Peripheral Blood Smear (PBS) is a laboratory test used to examine blood cells under a microscope. It
provides detailed information about the morphology (shape, size, and appearance) of red blood cells (RBCs),
white blood cells (WBCs), and platelets, aiding in the diagnosis of various hematologic and systemic
disorders.
Purpose of a PBS:
1. Evaluate abnormalities in blood counts from a Complete Blood Count (CBC).
2. Diagnose hematologic disorders such as anemia, leukemia, or infections.
3. Assess the presence of abnormal cells or inclusion bodies.
4. Monitor treatment progress in hematologic or infectious diseases.
Preparation of a Peripheral Blood Smear:
1. Sample Collection: Use fresh blood (preferably EDTA-anticoagulated).
2. Smear Technique:
• Place a small drop of blood on a clean glass slide.
• Spread the blood using a second slide at a 30–45° angle to create a thin, uniform film.
• Allow the slide to air dry completely.
3. Staining: Use Romanowsky stains (e.g., Wright, Giemsa, or Leishman stains) to enhance
cellular details.
Examination Under a Microscope:
1. Low Power Objective (10x):
• Assess the overall quality of the smear and distribution of cells.
• Check for clumps or uneven spreading.
2. High Power Objective (40x–100x):
• Examine RBC morphology, WBC differential, and platelet distribution.
Key Features Analyzed in PBS:
1. Red Blood Cells (RBCs):
• Normal Morphology: Biconcave discs, uniform size (7–8 µm).
• Abnormal Morphologies:
• Anisocytosis: Variation in size (e.g., microcytes in iron deficiency anemia, macrocytes in
megaloblastic anemia).
• Poikilocytosis: Variation in shape (e.g., sickle cells, spherocytes).
• Inclusions: Howell-Jolly bodies, basophilic stippling, or Heinz bodies.
2. White Blood Cells (WBCs):
• Normal Distribution: Neutrophils (40–70%), lymphocytes (20–40%), monocytes (2–10%),
eosinophils (1–6%), basophils (<1%).
• Abnormalities:
• Immature cells (blasts) in leukemias.
• Hypersegmented neutrophils in megaloblastic anemia.
• Reactive lymphocytes in viral infections.
3. Platelets:
• Normal Morphology: Small, round fragments (2–4 µm).
• Abnormalities:
• Giant platelets in myeloproliferative disorders.
• Reduced numbers in thrombocytopenia.
Common Findings in PBS:
• Anemia: Microcytic hypochromic RBCs (iron deficiency), macrocytic RBCs (vitamin B12 or
folate deficiency).
• Infections: Presence of reactive lymphocytes or toxic granulations in neutrophils.
• Leukemias: Presence of blasts, Auer rods (AML), or smudge cells (CLL).
• Thrombocytopenia: Reduced platelets or clumping.
Advantages of PBS:
1. Provides a quick and cost-effective diagnostic tool.
2. Complements automated blood analyzers by identifying morphological abnormalities.
3. Detects rare or subtle findings that may not be evident in automated tests.
Limitations of PBS:
1. Subjective interpretation requires experienced personnel.
2. May not quantify abnormalities as precisely as automated methods.
Clinical Applications:
• Diagnosing blood disorders (e.g., anemia, leukemia, or infections).
• Monitoring disease progression or treatment efficacy.
• Detecting parasitic infections such as malaria or microfilaria.
Key Points to Remember:
• A well-prepared and properly stained PBS is essential for accurate analysis.
• It provides invaluable information about cell morphology that complements CBC results.
• Morphologic abnormalities often indicate specific diseases or physiological conditions.
This review summarizes the essential aspects of PBS. Let me know if you’d like additional details or
examples!
