関: specific disorders

WordNet

stain by smearing or daubing with a dirty substance
a thin tissue or blood sample spread on a glass slide and stained for cytologic examination and diagnosis under a microscope (同)cytologic smear, cytosmear
slanderous defamation (同)vilification, malignment
make a smudge on; soil by smudging (同)blur, smudge, smutch
smear with blood, as in a hunting initiation rite, where the face of a person is smeared with the blood of the kill
temperament or disposition; "a person of hot blood"
people viewed as members of a group; "we need more young blood in this organization"
the fluid (red in vertebrates) that is pumped through the body by the heart and contains plasma, blood cells, and platelets; "blood carries oxygen and nutrients to the tissues and carries away waste products"; "the ancients believed that blood was the sea
related to the key issue but not of central importance; "a peripheral interest"; "energy is far from a peripheral issue in the economy"; "peripheral issues"
(computer science) electronic equipment connected by cable to the CPU of a computer; "disk drives and printers are important peripherals" (同)computer peripheral, peripheral device
on or near an edge or constituting an outer boundary; the outer area; "Russias peripheral provinces"; "peripheral suburbs"

PrepTutorEJDIC

(油性・粘着性のものを)…に塗る…(…で)…‘を'汚す《+『名』+『with』+『名』〈油など〉》 / (…に)〈油など〉‘を'塗りつける《+『名』〈油など〉+『on』(『over』)+『名』》 / …‘を'こすって不明瞭にする,消す / 〈人の名誉など〉‘を'傷つける,中傷する / 汚れる / かすれる,分鮮明になる / (油などの)汚れ,しみ / 中傷 / (顕微鏡で見るためスライドに塗った)塗布[標本]
『血』,『血』液 / 流血(bloodshed);殺人 / 気質,気性,血気,血潮 / 『血統』,血縁(kinship);生まれ,家柄;《the~》王家の血統 / (人種・出身国の)系 / 〈人〉‘に'初めての経験をさせる / 〈猟犬〉‘に'初めて獲物を血を味わわせる
周囲の; 周辺（装置）の・末梢的な・重要でない; （...に比べて）瑣末な (to); 【医】末端部の; コンピュータの周辺装置
純血の,純種の / 《複合語を作って》「…の血(性質)を持った」の意を表す

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/04/10 18:03:28」(JST)

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A blood film or peripheral blood smear is a thin layer of blood smeared on a microscope slide and then stained in such a way to allow the various blood cells to be examined microscopically. Blood films are usually examined to investigate hematological problems (disorders of the blood) and, occasionally, to look for parasites within the blood such as malaria and filaria.

Preparation

Two push-type peripheral blood smears suitable for characterization of cellular blood elements. Left smear is unstained, right smear is stained with Wright-Giemsa stain.

Blood films are made by placing a drop of blood on one end of a slide, and 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. The monolayer is found in the "feathered edge" created by the spreader slide as it draws the blood forward.

Unstained

Wright-Giemsa stained

Closeups of the feathered edge of blood smears. The pale middle band of the gradient is the monolayer.

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.

Routine analysis of blood in medical laboratories is usually performed on blood films stained with Romanowsky, Wright's, or Giemsa stain. 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.

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.

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).

White blood cells are classified according to their propensity to stain with particular substances, the shape of the nuclei and the granular inclusions.

Neutrophil granulocytes usually make up close to 80% of the white count. They have multilobate nuclei and lightly staining granules. They assist in destruction of foreign particles by the immune system by phagocytosis and intracellular killing.
Eosinophil granulocytes have granules that stain with eosin and play a role in allergy and parasitic disease. Eos have a multilobate nucleus.
Basophil granulocytes are only seen occasionally. They are polymorphonucleated and their granules stain dark with alkaline stains, such as haematoxylin. They are further characterised by the fact that the granules seem to overlie the nucleus. Basophils are similar if not identical in cell lineage to mast cells, although no conclusive evidence to this end has been shown. Mast cells are "tissue basophils" and mediate certain immune reactions to allergens.
Lymphocytes have very little cytoplasm and a large nucleus (high NC ratio) and are responsible for antigen-specific immune functions, either by antibodies (B cell) or by direct cytotoxicity (T cell). The distinction between B and T cells cannot be made by light microscopy.
Plasma cells are mature B lymphocytes that engage in the production of one specific antibody. They are characterised by light basophilic staining and a very eccentric nucleus.
Other cells are white cell precursors. When these are very abundant it can be a feature of infection or leukemia, although the most common types of leukemia (CML and CLL) are characterised by mature cells, and have more of an abnormal appearance on light microscopy (additional tests can aid the diagnosis).

Malaria

Blood smear from a P. falciparum culture (K1 strain). Several red blood cells have ring stages inside them. Close to the center there is a schizont and on the left a trophozoite.

The preferred and most reliable diagnosis of malaria is microscopic examination of blood films, because each of the four major parasite species has distinguishing characteristics. Two sorts of blood film are traditionally used. Thin films are similar to usual blood films and allow species identification, because the parasite's appearance is best preserved in this preparation. Thick films allow the microscopist to screen a larger volume of blood and are about eleven times more sensitive than the thin film, so picking up low levels of infection is easier on the thick film, but the appearance of the parasite is much more distorted and therefore distinguishing between the different species can be much more difficult.^[1] From the thick film, an experienced microscopist can detect all parasites they encounter. Microscopic diagnosis can be difficult because the early trophozoites ("ring form") of all four species look identical and it is never possible to diagnose species on the basis of a single ring form; species identification is always based on several trophozoites. Please refer to the chapters on each parasite for their microscopic appearances: P. falciparum, P. vivax, P. ovale, P. malariae.

The biggest pitfall in most laboratories in developed countries is leaving too great a delay between taking the blood sample and making the blood films. As blood cools to room temperature, male gametocytes will divide and release microgametes: these are long sinuous filamentous structures that can be mistaken for organisms such as Borrelia. If the blood is kept at warmer temperatures, schizonts will rupture and merozoites invading erythrocytes will mistakenly give the appearance of the accolé form of P. falciparum. If P. vivax or P. ovale is left for several hours in EDTA, the buildup of acid in the sample will cause the parasitised erythrocytes to shrink and the parasite will roll up, simulating the appearance of P. malariae. This problem is made worse if anticoagulants such as heparin or citrate are used. The anticoagulant that causes the least problems is EDTA. Romanowsky stain or a variant stain is usually used. Some laboratories mistakenly use the same staining pH as they do for routine haematology blood films (pH 6.8): malaria blood films must be stained at pH 7.2, or Schüffner's dots and James's dots will not be seen.

Popular culture

In the television series Dexter, serial killer Dexter Morgan keeps samples of his victims' bloods in blood slides.

References

^ Warhurst DC, Williams JE (1996). "Laboratory diagnosis of malaria". J Clin Pathol 49 (7): 533–38. doi:10.1136/jcp.49.7.533. PMC 500564. PMID 8813948.

UpToDate Contents

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1. 末梢血塗抹標本の評価 evaluation of the peripheral blood smear
2. 貧血を有する成人患者に対するアプローチ approach to the adult patient with anemia
3. Drug-induced thrombotic microangiopathy
4. 脾腫を有する小児に対するアプローチ approach to the child with an enlarged spleen
5. 成人における溶血性貧血の診断へのアプローチ approach to the diagnosis of hemolytic anemia in the adult

English Journal

Re-evaluation of Need for Bone Marrow Examination in Patients with Isolated Thrombocytopenia Contributors.

Purohit A1, Aggarwal M1, Singh PK1, Mahapatra M1, Seth T1, Tyagi S1, Saxena R1, Pati HP1, Mishra P1.
Indian journal of hematology & blood transfusion : an official journal of Indian Society of Hematology and Blood Transfusion.Indian J Hematol Blood Transfus.2016 Jun;32(2):193-6. doi: 10.1007/s12288-015-0533-2. Epub 2015 Mar 28.
Diagnosis of immune thrombocytopenia (ITP) is based on clinical suspicion and normal peripheral smear except for thrombocytopenia. Bone marrow examination is carried out to rule out leukemia, myelodysplastic syndrome or aplastic anemia. However, in most cases, clinical diagnosis is not altered after
PMID 27065582

Detection of Apoptotic Lymphocytes Through Sysmex XN-1000 As a Diagnostic Marker for Mononucleosis Syndrome.

Salve S1, Carone AE1, Fumi M1, Pancione Y1, Rocco V1.
Journal of clinical laboratory analysis.J Clin Lab Anal.2016 Apr 19. doi: 10.1002/jcla.21938. [Epub ahead of print]
BACKGROUND: The infectious mononucleosis (IM) includes clue elements, apoptotic and atypical lymphocytes. In IM, the evaluation of dot plot provided by Sysmex XN-1000 analyzer revealed a stretched lymphocytic cluster, white cell differential channel (WDF), on cytogram.METHODS: In this study, we anal
PMID 27094572

Refining peripheral blood smear review rules for neonatal inpatients in a South African academic laboratory.

Vaughan J1,2, Alli N1,2, Mannaru K1, Sedick Q1.
International journal of laboratory hematology.Int J Lab Hematol.2016 Apr 17. doi: 10.1111/ijlh.12491. [Epub ahead of print]
INTRODUCTION: Peripheral blood smear review (PBSR) is a labour-intensive test, and skilled morphologists are in short supply. It is therefore helpful for laboratories to establish rules for PBSR to improve laboratory efficiency. Previously published guidelines in this regard are useful, but make few
PMID 27087063

Japanese Journal

Streptococcus pneumoniae Detected on a Peripheral Blood Smear

Sakaguchi Shota,Kisanuki Atsushi,Hara Seiichiro,Okayama Akihiko
Internal Medicine 53(4), 347-347, 2014
NAID 130003392660

Development of Adult T-cell Leukemia in a Patient with Rheumatoid Arthritis Treated with Tocilizumab

Nakamura Hideki,Ueki Yukitaka,Saito Shigeki,Horai Yoshiro,Suzuki Takahisa,Naoe Tomoki,Eguchi Katsumi,Kawakami Atsushi
Internal Medicine 52(17), 1983-1986, 2013
… The patient was an human T-lymphotropic virus type I (HTLV-I) carrier, and, in April 2011, a peripheral blood smear showed many atypical lymphocytes, thus leading to a diagnosis of adult T-cell leukemia (ATL). …
NAID 130003365781

Chédiak-Higashi症候群の血球貪食性リンパ組織球症としての臨床像

宮前多佳子,井崎桜子,生田孝一郎,横田俊平,山中寿
日本臨床免疫学会会誌 36(4), 226-232, 2013
Chédiak-Higashi症候群は原発性免疫不全症候群のひとつに分類され，わが国では約14例の報告があるに過ぎない．臨床的には易感染性，部分白子症（特異な白銀髪，虹彩色素の減少，乳白色で，紫外線により赤味を帯びる皮膚），出血傾向，進行性神経障害を特徴とするが，accelerated phaseと呼ばれる増悪期には，発熱，脾腫，骨髄抑制などを伴う血球貪食性リンパ組織球症を併発する．また，主に …
NAID 130003364183

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