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    Peripheral Smear (Blood Picture) Test

    Also known as  MP Blood Smear | Smear for Malarial Parasite
    A blood smear is a blood test that gives clear information about the number and shape of blood cells. It is usually done as part of the complete blood count(CBC).
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    What is the Peripheral Smear (Blood Picture) test? 

    A peripheral smear test determines the different components of the blood.The smear evaluates the red blood cells (RBC), white blood cells (WBC),and platelets as well as any other abnormalities, such as the presence ofparasites. A blood smear test is ordered to diagnose the causes ofunexplained jaundice, unexplained anaemia, unknown fever, and severeinfection in the body.

    The number and appearance of the blood cells can be affected by severaldiseases. For example, smaller size of RBCs can indicate a type ofanaemia, whereas increased number of WBCs might indicate infection.

    A blood smear test is considered normal when the sample contains theoptimum number, size, and shape of the blood cells. The results areconsidered abnormal when cells have an abnormality in shape, size, ornumber.

    What are the other names for the Peripheral Smear (Blood Picture)test? 

    The other names are Blood Picture, PBS Test, Peripheral Blood Film, andBlood Morphology Test. 

    What are the test parameters included in the Peripheral Smear (BloodPicture) test?

    There is only one parameter.


    What does a Peripheral smear (Blood Picture) test measure?

    A blood smear is a study of the cells that are present in the blood atthe time the sample is collected. The blood smear allows for thedetermination of these cells:

    • White blood cells (WBCs or leukocytes) help to fight infections orare present in the immune response.

    • Red blood cells (RBCs, erythrocytes) carry oxygen to the tissuesacross the body.

    • Platelets (thrombocytes) are tiny cell fragments that are very vitalfor proper blood clotting. 


    These cell populations are manufactured and mainly mature in the bonemarrow and are eventually released into the bloodstream as required. Thenumber and type of each cell present in the blood are dynamic, but theyare generally maintained by the body within specific ranges. 


    The small drop of blood on the slide used for a blood smear containsmillions of RBCs, thousands of WBCs, and hundreds of thousands ofplatelets. The blood smear examination is as follows:

    • It evaluates WBC’s size, shape, and appearance.It also defines fivetypes of WBCs and their relative percentages (WBC manual differentialcounts).

    • It evaluates the size, shape, and colour (indicators of haemoglobincontent) of the RBCs or RBC morphologies.

    • Estimates the total number of platelets present in the smear.


    Different types of diseases and conditions can affect the number andappearance of blood cells. The examination of the blood smear can be usedto support the findings from other tests and examinations. For example,RBCs that appear smaller and paler than normal may be associated withother results that indicate a type of anaemia. Similarly, the presence ofWBCs that are not fully mature may add to the information from the othertests to help make a diagnosis of infection, malignancy, or otherconditions.    


    What’s the normal range of Peripheral smear (Blood Picture)? 

    A blood smear is considered normal when your blood contains a sufficientnumber of cells; that is, the differential count should be 100 cells,including all five types of WBCs; the total WBC count should be between4000 and 11000 cells, and the cells should have a normal appearance. Ablood smear is considered abnormal when the size, shape, colour, or numberof cells in your blood is not normal.

    Who should get a Peripheral Smear (Blood Picture) test? 

    Usually, the blood smear is primarily recommended as a follow-up testwhen a CBC test with the differential count is performed with an automatedblood cell counter, and it indicates the presence of atypical, abnormal,or immature cells. This may also be performed when a person has signs andsymptoms that suggest a condition is affecting blood cell production orthe lifespan.


    The signs and symptoms which might indicate one of these blood disordersinclude:

    • Weakness, fatigue

    • Pale skin complexion

    • Unexplained jaundice, that is, yellowing of the skin and the whitesof the eyes.

    • Fever

    • Excessive bleeding episodes, easy bruising, or frequent nosebleeds.

    • Enlargement of the spleen

    • Bone pain

    A blood smear can also be ordered on a regular basis when a person isbeing treated or monitored for a blood cell-related disease.


    Are there any preparations needed for the Peripheral Smear (BloodPicture) test?

    No special preparation is required. Fasting is not required for thistest. Please ask the doctor if there are any precautions to betaken.

    What is the cost of a Peripheral Smear (Blood Picture) test?

    What is the type of sample required? 

    This test requires a blood sample.

    Who processes the Peripheral Smear (Blood Picture) test?

    A healthcare provider, who is also called a phlebotomist, usuallyperforms blood draws, including those for peripheral smear tests, but anyhealthcare provider trained in drawing blood can perform this task. Thesesamples are sent to a lab where a medical laboratory scientist preparesthe samples and performs the tests on analysers or manually.

    What should I expect during my Peripheral Smear (Blood Picture)test?

    You can expect to experience the following during the blood test or ablood draw:

    • You can feel the experience of the following during the blood test orblood draw.

    • You have to sit comfortably on the chair, and the phlebotomist willcheck your arms for an easily accessible vein. This is the inner partof your arm on the other side of your elbow.

    • Once the phlebotomist has located a vein, they will disinfect thearea with an alcohol swab.

    • They will insert the needle into your vein to draw a blood sample.This might feel like a small pinch.

    • After they insert the needle, the required amount of blood will bedrawn into a test tube.

    • When they have drawn enough blood for the test, they’ll remove theneedle and hold a cotton ball or gauze on the site to stop anybleeding.

    • They will apply a band-aid over the pricked site, and the bloodcollection is finished.

    This process takes less than five minutes.

    What should I expect after my Peripheral Smear (Blood Picture)test?

    Once the phlebotomist has collected the blood sample, it will be sent tothe laboratory for processing or testing. When the reports are ready, yourhealthcare provider will share the results with you.

    What are the risks of a Peripheral Smear (Blood Picture) test?

    These blood tests are common, and they don’t carry any significant risks.You might have a slight pain like an ant bite when the needle getsinserted, and a small bruise can develop there.

    When can I expect my Peripheral Smear (Blood Picture) test results?

    At Orange Health, peripheral smear test reports are available within 6hours.

    What do the results of a Peripheral Smear (Blood Picture) testmean? 



    Microscopic findings from blood smear evaluation are not alwaysdiagnostic in themselves and more often indicate the possibility orpresence of an underlying condition, its severity, and the need forfurther diagnostic testing. These results are taken into considerationwith the results of the CBC and other diagnostic tests as well as thetested person's clinical history of symptoms.


    The results of a blood smear typically include a description of theappearance of the red blood cells, white blood cells, and platelets aswell as any abnormalities that might be seen on the slide.


    Red Blood Cells (RBCs)

    Normal, mature red blood cells are uniform in size (7-8µm in diameter)and do not have a nucleus as most other cells do. They are round andflattened like a donut with a depression in the centre instead of a holeor biconcave. It is due to the haemoglobin inside the RBCs that theyappear pink to red in colour with a pale centre after staining with theblood smear. When the appearance of RBCs (RBC morphology) is normal, it isoften reported as a normochromic and normocytic blood picture.


    While not every RBC will be perfect, any significant number of cells thatare different in shape or size can indicate the presence of disease. Someof the examples of conditions that may affect red blood cellsinclude:

    • Anaemia

    • Haemoglobin variants include sickle cell anaemia andthalassemia.

    • Leukaemia

    • Myeloproliferative or myelodysplastic neoplasms

    • Bone marrow disorders


    There can be one or more RBC irregularities seen on a blood smear. Twoexamples include

    • Anisocytosis: Variable sizes of red blood cells can indicate anaemia;RBCs smaller than normal are referred to as microcytes, and RBCslarger than normal are called macrocytes.

    • Poikilocytosis: Several shapes of red cells may include burr cells(echinocytes), acanthocytes, elliptocytes, rouleaux, sickle cells,target cells, teardrop cells, and schistocytes (red cell fragments,helmet cells).

    • Anisopoikilocytosis: variability in both RBC size and shape.


    White Blood Cells (WBCs)

    A manual WBC differential can be performed as a part of a blood smearevaluation. Typically, at least 100 WBCs are evaluated and categorisedaccording to type. The percentage of each type is calculated. In additionto this, the appearance (morphology) and the stage of development of theWBCs are noted.


    Numerous diseases and conditions may affect the absolute or relativenumber of WBCs and their appearance on a blood smear. Some of theconditions include

    • Infections and or inflammation - which may increase certain types ofWBCs.

    • Bone marrow disorders - depending on the condition, can increase ordecrease absolute and relative numbers of WBCs.

    • Allergies - can affect the number of eosinophils.

    • In leukaemia, myelodysplastic syndrome, or myeloproliferativeneoplasm,- immature white blood cells such as blasts can be seen onthe blood smear’ blasts are normally found in the bone marrow whereWBCs are manufactured and mature before being released into the blood.If blasts are seen on a blood smear, they can indicate a serious bonemarrow disease. They can also be seen in other scenarios, such as whenthe bone marrow is recovering or regenerating from chemotherapy, or asanother example, stimulated by a medication prior to stem cellcollection.



    There are cell fragments that have developed from large bone marrowcalled megakaryocytes. Upon release from the bone marrow, they appear asfragments in the peripheral blood. When there is blood vessel injury oranother bleeding, the platelets become activated and begin to clumptogether to form aggregates, which is the beginning of a blood clot. 


    There must be a sufficient number of platelets to control bleeding. Ifthere are too few, or if they don’t function properly, the ability to forma clot becomes impaired and can be a life-threatening situation. In somepeople, too many platelets may be produced, which can result ininterference with the flow of blood, increasing a person’s risk ofdeveloping a blood clot. These same people can also experience bleedingbecause many of the extra platelets may be dysfunctional even though theyappear normal.


    A platelet count is usually part of a CBC. An abnormally low number orthe high number of platelets can be further determined by preparing ablood smear to directly visualise any anomalies in shape or size. Forexample, the large platelets or giant platelets can be seen as the bonemarrow tries to compensate for a low platelet count, but they can also beseen in myeloproliferative neoplasms or immune thrombocytopenia, acondition in which the immune system inappropriately produces antibodiesdirected against the platelets.


    What are normal Peripheral Smear (Blood Picture) test results?

    The doctor will check the blood smear under the microscope. A blood smearis considered normal when your blood contains a sufficient number of cellsand the cells have a normal appearance. A blood smear is consideredabnormal when the size, shape, colour, or number of cells in your blood isnot normal.

    The normal ranges can vary slightly among different laboratories. Some ofthe labs use different measurements or might do tests on the differentsamples. Speak to your healthcare provider about the meaning of yourspecific test results.


    What other tests might I have along with this test?

    Complete Haemogram


    How do I book a Peripheral Smear (Blood Picture) test at home?

    Log on towww.orangehealth.inand submit your details. Our highly trained, professional, and vaccinatedeMedics will be at your doorstep within 60 minutes or at the time bookedby you.

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