Recommendation for the Peripheral Blood Cell Morphology Report

Jung Ah Kwon; Young-gon Kim; Geon Park; Ji-myung Kim; Young-Uk Cho; Jungwon Huh; Sun-Young Kong; Jin-Yeong Han; Soo-Young Yoon

doi:10.3343/lmo.2019.9.3.115

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Kwon, Kim, Park, Kim, Cho, Huh, Kong, Han, and Yoon: Recommendation for the Peripheral Blood Cell Morphology Report

Original Article

Lab Med Online 2019;9(3):115-125.

Published online: 20 July 2019

DOI: https://doi.org/10.3343/lmo.2019.9.3.115

Recommendation for the Peripheral Blood Cell Morphology Report

Jung Ah Kwon, M.D.¹, Young-gon Kim, M.D.¹, Geon Park, M.D.², Ji-myung Kim, M.D.³, Young-Uk Cho, M.D.⁴, Jungwon Huh, M.D.⁵, Sun-Young Kong, M.D.⁶, Jin-Yeong Han, M.D.⁷, Soo-Young Yoon, M.D.^1,

¹Department of Laboratory Medicine, Korea University College of Medicine, Seoul, Korea

²Department of Laboratory Medicine, Chosun University College of Medicine, Gwangju, Korea

³Department of Laboratory Medicine, Chungnam Natonal University College of Medicine, Daejeon, Korea

⁴Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea

⁵Department of Laboratory Medicine, Ewha Womens University College of Medicine, Seoul, Korea

⁶Department of Laboratory Medicine, National Cancer Center, Seoul, Korea

⁷Department 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

Received 20 August 2018 Revised 4 December 2018 Accepted 27 December 2018

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.

Keywords: Blood cell morphology, Grading system, Standardization

References

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Table 1.

Grading table for red blood cell morphology

세포명	보고등급
세포명	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.

Table 2.

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 perfringens^패혈증, ^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

Table 3.

Reference range of white blood cell counts according to age

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

Table 4.

Grading table for white blood cell and platelet morphologies

세포명	보고등급
세포명	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.

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