lmo Laboratory Medicine Online Lab Med Online ∗∗ 2093-6338 The Korean Society for Laboratory Medicine 10.3343/lmo.2019.9.3.115 lmo-9-115 Original Article Recommendation for the Peripheral Blood Cell Morphology Report KwonJung AhM.D. 1 KimYoung-gonM.D. 1 ParkGeonM.D. 2 KimJi-myungM.D. 3 ChoYoung-UkM.D. 4 HuhJungwonM.D. 5 KongSun-YoungM.D. 6 HanJin-YeongM.D. 7 YoonSoo-YoungM.D. 1 Department of Laboratory Medicine, Korea University College of Medicine, Seoul, Korea Department of Laboratory Medicine, Chosun University College of Medicine, Gwangju, Korea Department of Laboratory Medicine, Chungnam Natonal University College of Medicine, Daejeon, Korea Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea Department of Laboratory Medicine, Ewha Womens University College of Medicine, Seoul, Korea Department of Laboratory Medicine, National Cancer Center, Seoul, Korea Department of Laboratory Medicine, Dong-A University College of Medicine, Busan, Korea Corresponding author: Soo-Young Yoon, M.D., Ph.D. https://orcid.org/0000-0002-2302-3825 Department of Laboratory Medicine, Guro Hospital of Korea University, 148 Gurodong-ro, Guro-gu, Seoul 08308, Korea Tel: +82-2-2626-3246, Fax: +82-2-2626-1465, E-mail: labmd@korea.ac.kr 07 2019 20 07 2019 9 3 115 125 20082018 04122018 27122018 Copyright © 2019 The Korean Society for Laboratory Medicine 2019 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract

There is considerable heterogeneity in the peripheral blood smear reports across different diagnostic laboratories, despite following the guidelines published by the International Council for Standardization in Haematology (ICSH). As standardization of reports can facilitate communication and consequently the diagnostic efficiency in both laboratories and clinics, the standardization committee of the Korean Society for Laboratory Hematology aimed to establish a detailed guideline for the standardization of peripheral blood smear reports. Based on the ICSH guidelines, additionalissues on describing and grading the peripheral blood smear findings were discussed. In this report, the proposed guideline is briefly described.

 Blood cell morphology Grading system Standardization References Barnes PW McFadden SL Machin SJ Simson E The international consensus group for hematology review: suggested criteria for action following automated CBC and WBC differential analysis Lab Hematol 200511 8390 Constantino BT Reporting and grading of abnormal red blood cell morphology Int J Lab Hematol 201537 17 Bain BJ Blood cells: A practical guide 4th ed. Malden, Mass. Blackwell 2006 Palmer L Briggs C McFadden S Zini G Burthem J Rozenberg G ICSH recommendations for the standardization of nomenclature and grading of peripheral blood cell morphological features Int J Lab Hematol 201537 287303 Park G and Kim JM Peripheral blood smear morphology and report I Reston Korean Society for Laboratory Hematology 2011 Yoon SY Kwon JA Recommendation for the peripheral blood flm report Reston Korean Society for Laboratory Hematology 2018 Rümke C The statistically expected variability in diferrential counting. In: Koepke JA, ed. Differential leukocyte counting: CAP Conference/Aspen, 1977 Skokie, IL: College of American Pathologists 2006 3946 Zini G d'Onofrio G Briggs C Erber W Jou JM Lee SH ICSH recommendations for identifcation, diagnostic value, and quantitation of schistocytes Int J Lab Hematol 201234 10716 Tuffy P Brown AK Zuelzer WW Infantile pyknocytosis; a common erythrocyte abnormality of the frst trimester AMA J Dis Child 195998 22741 Bailey JW Williams J Bain BJ Parker-Williams J Chiodini PL Guideline: the laboratory diagnosis of malaria. General Haematology Task Force of the British Committee for Standards in Haematology Br J Haematol 2013163 57380 Goasguen JE Bennett JM Bain BJ Brunning R Vallespi MT Tomonaga M Proposal for refning the defnition of dysgranulopoiesis in acute myeloid leukemia and myelodysplastic syndromes Leuk Res 201438 44753 Swerdlow SH Campo E WHO classifcation of tumours of haematopoietic and lymphoid tissues Lyon, France: International Agency for Research on Cancer 2017 Korean Society for Laboratory Medicine Laboratory medicine 5th ed. Reston Panmuneducation 2014 1253 Kasper DL Fauci AS Harrison's principles of internal medicine 19th ed. New York McGraw-Hill education 2015 1188 Tables

Grading table for red blood cell morphology

세포명 보고등급
Few/1+ Mod/2+, %∗ Many/3+, %∗
적혈구부동증 N/A 11–20 >20
대적혈구 N/A 11–20 >20
소적혈구 N/A 11–20 >20
저색소적혈구 N/A 11–20 >20
다염성 N/A 5–20 >20
유극적혈구 N/A 5–20 >20
분열적혈구 <1% 1–2 >2
물림적혈구 N/A 1–2 >2
물집적혈구 N/A 1–2 >2
불규칙응축적혈구 N/A 1–2 >2
겸상적혈구 N/A 1–2 >2
난형 대적혈구 N/A 2–5 >5
톱니적혈구 N/A 5–20 >20
타원적혈구 N/A 5–20 >20
난형적혈구 N/A 5–20 >20
구상적혈구 N/A 5–20 >20
유구적혈구 N/A 5–20 >20
표적적혈구 N/A 5–20 >20
눈물방울적혈구 N/A 5–20 >20
변형적혈구증 N/A 5–20 >20
호염기반점 N/A 5–20 >20
Howell-Jolly 소체 N/A 2–3 >3
Pappenheimer 소체 N/A 2–3 >3

Percent of cells seen per field at 1000× magnification (oil immersion field). Abbreviations: Mod, moderate; N/A, not applicable.

Common synonyms for red blood cell morphology and related clinical conditions

표준적혈구용어 동의어 자주 동반되는 임상 양상
대적혈구 macrocyte, macronormocyte, megalocyte 비타민B12/엽산결핍증, 간질환, 골수형성이상증후군
소적혈구 microcyte, micronormocyte 철결핍빈혈, 이상혈색소증
저색소적혈구 anulocyte, pessary form, ring form 철결핍빈혈, 지중해빈혈
다염적혈구 polychromatic cells, polychromatophilic cell 용혈빈혈, 빈혈 치료
타원적혈구 elliptocyte, bacillary cell, cigar or rod-shaped cell, ovalocyte, pencil cell 유전타원적혈구증, 철결핍빈혈
난형적혈구 ovalocyte, bacillary cell, cigar or rod-shaped cell, elliptocyte 유전타원적혈구증, 철결핍빈혈
톱니적혈구 echinocyte, berry cell, burr cell, crenated cell, mulberry cell, poikilocyte, pyknocyte, spiculated cell, spur cell, sputnik cell, star cell 간질환, 신장질환, PK결핍증, 보관이상(storage artefact)
분열적혈구 schistocyte, helmet cell, horn cell, keratoschistocyte, pincer cell, poikilocyte, prickle cell, red cell fragment, schizocyte, thorn cell, triangular cell 미세혈관병용혈빈혈, 혈전혈소판감소자색반병, 용혈요독증후군, 파종혈관내응고, 신질환
겸상적혈구 sickle cell, drepanocyte, holly leaf cell 겸상적혈구증
구상적혈구 spherocyte, spherical cell 유전구상적혈구증, 자가면역용혈빈혈 ABO불일치 용혈빈혈, Clostridium perfringens패혈증, 화상
유구적혈구 stomatocyte, cup cell, knizocyte, slit cell 알코올성 간질환, 유전유구적혈구증
표적적혈구 target cell, codocyte, leptocyte 간질환, 이상혈색소증, 지중해빈혈
눈물방울적혈구 teardrop cell, dacrocyte, pear-shaped cell 골수섬유증
유극적혈구 acanthocyte, acanthoid cell, astrocyte, burr cell, prickle cell, pyknocyte, star cell, spur cell, thorn cell 간질환, 비타민E 결핍증, 비장절제술후, 무베타지질단백혈증, McLeod 적혈구 표현형
물림적혈구 bite cell, keratocytes G6PD 결핍증
물집적혈구 blister cell, puddle cell, eccentrocyte 산화용혈(oxidative hemolysis), G6PD결핍증
불규칙응축적혈구 irregularly contracted cell G6PD결핍증, 이상혈색소증
형태이상적혈구 poikilocyte, irregular shaped cell, 골수형성이상증후군
호염기성 반점 basophilic stippling, punctate basophilia 납중독, 헴합성 이상증, 지중해빈혈, 이상혈색소증
파펜하이머 소체 Pappenheimer bodies 철적혈모세포빈혈, 이상혈색소증, 비기능감퇴증
Howell-Jolly 소체 Howell-Jolly bodies 비장절제술후, 용혈빈혈, 거대적혈모구빈혈, 비기능감퇴증

Reference range of white blood cell counts according to age

나이 백혈구수 호중구 림프구 단구 호산구
(×10³/µL) (×10³/µL) (×10³/µL) (%) (%)
출생 시 9.0–30.0 6.0–26.0 2.0–11.0 6 2
12시간 내 13.0–38.0 6.0–28.0 2.0–11.0 5 2
24시간 내 9.4–34.0 5.0–21.0 2.0–11.5 6 2
1주 5.0–21.0 1.5–10.0 2.0–17.0 9 4
2주 5.0–20.0 1.0–9.5 2.0–17.0 9 3
1개월 5.0–19.5 1.0–9.0 2.5–16.5 7 3
6개월 6.0–17.5 1.0–8.5 4.0–13.5 5 3
1세 6.0–17.5 1.5–8.5 4.0–10.5 5 3
2세 6.0–17.5 1.5–8.5 3.0–9.5 5 3
4세 5.5–15.5 1.5–8.5 2.0–8.0 5 3
6세 5.0–14.5 1.5–8.0 1.5–7.0 5 3
8세 4.5–13.5 1.5–8.0 1.5–6.8 4 2
10세 4.5–13.5 1.8–8.0 1.5–6.5 4 2
16세 4.5–13.0 1.8–8.0 1.2–5.2 5 3
21세 이상 4.5–11.0 1.8–7.8 1.0–4.8 4 3

Grading table for white blood cell and platelet morphologies

세포명 보고등급
Few/1+ Mod/2+, %∗ Many/3+, %∗
세포질공포(호중구) N/A 4–8 >8
저과립구(호중구) N/A 4–8 >8
독성과립(호중구) N/A 4–8 >8
Döhle 소체 N/A 2–4 >4
거대 혈소판 N/A 11–20 >20

Percent of cells seen per field at 1,000 × magnification (oil immersion field). Abbreviations: Mod, moderate; N/A, not applicable.