Peripheral Blood Smear (2025-11-19)
Sources
Peripheral Blood Smear — 2025-11-19
Lab: DDRC Agilus Pathlabs, Medical College, Trivandrum
Accession: 4182YK007574
Method: Leishman staining + microscopy
Pathologist: Dr. Vaishali Rajan, MBBS DCP (Reg TCC 27150)
Findings
RBC
- Mostly normocytic normochromic
- Few cells show mild hypochromia and anisocytosis
- Few microcytes, elongated cells, and ovalocytes seen
- Polychromic RBCs (+)
- No nucleated RBCs seen
WBC
- Count mildly decreased (2000–3000/cumm approximately)
- Differential shows eosinophil predominance (13%)
- Few atypical (reactive) lymphocytes seen (3%)
- Occasional band form seen
Platelets
- Count mildly decreased (60,000–80,000/cumm approximately)
- Seen singly in the smear
- Occasional giant form seen
- Haemoparasites: Not identified
Impression
- RBC — Normochromic normocytic picture (Hb 8.3 g/dL)
- Leucopenia with relative eosinophil predominance
- Thrombocytopenia
- Kindly correlate clinically.
Clinical Context
This peripheral smear was obtained as part of the pre-AML-diagnosis workup. The pancytopenia pattern (anemia, leucopenia, thrombocytopenia) seen here was the initial presentation that prompted the autoimmune workup (Ana, Anti Dsdna, Anti Ccp, Complement C3, Complement C4) and ultimately the bone marrow biopsies (Bone Marrow Biopsy 2025 11 20, Bone Marrow Biopsy 2025 11 28) that confirmed Aml.
Notable findings:
- Eosinophil predominance (13%) is atypical for AML and raised the differential diagnosis of eosinophilic disorders, parasitic infection, or allergic conditions. This was also reflected in the elevated Total Ige (203.1 and 134.4 IU/mL in 2022).
- No blasts identified on peripheral smear — the leukemic blasts were primarily in the bone marrow, consistent with the flow cytometry finding of ~5% blasts.
- No nucleated RBCs and no haemoparasites — useful negative findings.