Clinical Hematology – Peripheral Blood Smear Preparation

preparation of an adequate slide is essential when performing a manual differential a well-made peripheral blood smear should be a minimum of one inch in length it should be evenly spread with a gradual transition from thick to then terminating at a feathered edge this will allow for an even distribution of cells the scenario precipitate streaks holes and should not have a thick accumulation of cells at the feathered edge in order to prepare a manual smear you will need EDTA anticoagulated blood slides gauze applicator sticks pencil and your personal protective equipment such as lab coat gloves and the face shield the first thing you want to do is invert the tube of blood six to ten times gently using two applicator sticks check the specimen for clots if a clause present regardless of its size the specimen must be redrawn a clouded specimen will affect all parameters especially the platelets and white blood cells near the frosted end of a clean glass slide place a small drop of blood at a 30 to 40 degree angle pull the spreader slide to the edge of the drop once the blood spreads across the width of the slide gently pushed to the left in a smooth and steady motion however moving the spreader slide too rapidly will result in a shorter thicker smear moving the spreader slide too slowly will lead to a poor white blood cell distribution by pushing larger cells to the end of the slide once you have finished preparing your smear labeled the frosted end of the slide with the patient's order number last name first initial and date here are some examples of adequate smears they take up approximately two-thirds of the slide length they have a gradual transition from thick to thin terminating at a feathered edge they are free from precipitate streaks holes and there is no thick accumulation of cells at the feathered edge here are a few examples of poorly made smears this smear extends the entire length of the slide using a larger angle or a smaller drop of blood will prevent running off the slide when spreading this slide does not need the 1-inch minimum requirement the smear is inconsistent due to uneven pressure caused the hesitation when spreading and has a thick accumulation of cells at the feathered edge the length of the slide could be corrected by using a larger drop of blood or decreasing the angle of the spreader slide using a quick and fluid motion will prevent any lines across the width of the slide and the thick cell pile up at the feathered edge this slide exhibits streaking across the center due to the partial drawing of the drop of blood prior to spreading spreading the blood as soon as possible will stop any streaks from forming this slide is inadequate due to the presence of holes and precipitate to prevent this from occurring ensure that the slides are clean before preparing the smear these are some examples of peripheral blood smears that have been write stained when looking at a stain smear under the microscope be sure to use the battlenet pattern when looking at a stained peripheral blood smear under the microscope this is an example of the lacy portion of the feathered edge this is an example of a good area to begin a differential the cells are evenly distributed and close but not touching one another this is an example of an area on the smear that is too thick to perform a differential

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