Full Blood Picture

Definition

FBP = FBC + Differential count (DC) + Histogram + Peripheral Blood Film (PBF)

FBP = Haemogram + PBF

Haemogram = FBC + DC + Histogram

FBC = CBC = Complete Blood Count

Concept

Haemopoiesis occur in Bone Marrow

Mature cells circulate in periphery

Pathological process in marrow is reflected in periphery

Extramedullary pathology can cause abnormal peripheral blood picture

Based on Morphology, Counts

Indications

Clinical suspicion of bl ood disorders

Severe anaemia prior to blood transfusion

Abnormal FBC/ Histogram

Assessment of known blood disorders

Routine medical examination

Reporting

RBC : Hb level + Morphology + Others

WBC : Counts + Morphology + Others

Platelet : Counts + Morphology

Impression :

Suggestion :

Blood Film in Healthy Subjects

Healthy Adults

Slight Anisocytosis/ Poikilocytosis

Metamyelocytes/ Myelocytes – rare

Megakaryocytes – very rare

RBC : Platelet = 10-40 : 1

Pregnancy

More variation

↑ MCV (30-35 weeks)

↓ Hb (30-34 weeks)

↑ ESR (Rouleaux)

Numerous polychromatic cells

↑ Retic. Count (6% at 25-30 weeks)

↑ Neutrophil/ Monocyte count

Left Shift

Platelet - Count/ Size usually do not change

Infant & Children

MCV/ MCH ↓ compared to adults

Male- Female have difference in Hb

(RBC, PCV/Hct not present before puberty)

Lymphocyte count ↑

Neonate

Hyposplenic features – Howell-Jolly Bodies, Acanthocytes, Spehrocytes

Hb, RBC, PCV ↑

MCV ↑

Neutrophil, Monocyte, Lymphocyte counts ↑

NRBC & Myelocytes – common

Retic. Count ↑ in 1st

3 days after birth

Premature Neonate ↑ NRBC, Metamyelocytes, Myelocytes, Promyelocytes, Myeloblasts

Hyposplenic features

Develop eosinophilia often (between 2nd

– 3rd

weeks after birth)

Hyposplenism

After splenectomy – Thrombocytosis, Neutrophilia

After Recovery – Neutrophil counts nearly Normal, Platelet high Normal

Lymphocytosis, Monocytosis persist

Abnormal RBC features

Target cells

Acanthocytes

Howell-Jolly bodies

Pappenheimer bodies

NRBC

Spherocytes

Circulating non-haemopoietic cells Microorganisms in Blood Film

Endothelial cells Bacteria

Epithelial cells Fungi

Non-haemopoietic malignant cells Parasites

Morphology of Blood Cells

Erythrocytes

Normal morphology

(normocytosis normochromia)

(non-poikilocytic, poikilocytic)

Anisocytosis

(microcytosis, macrocytosis)

Poikilocytosis

Anisochromasia

(hypochromia, hyperchromia)

Polychromasia

Dimorphism

Inclusion bodies

Nucleated red cells

Agglutination

Rouleaux formation

Classification of Poikilocytes

Round Elongated Spiculated

Spherocytes Ovalocytes/ elliptocytes Schistocytes

Stomatocytes Teardrop cells Keratocytes

Target cells Sickle cells Echinocytes

Hb C crystalloids Acanthocytes

HB S-C hybrids

Inclusions in Erythrocytes

Howell-Jolly Bodies

Basophilic Stippling

Pappenheimer Bodies

Malarial Parasite

Reticulocyte

Heinz Bodies

Leucocytes

Platelets/ Thrombocytes

Normal

Large

Giant

Platelet clumps

Platelet satellitism

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