Examining a Mammalian Blood
Smear
The distribution and appearance of
the formed elements of blood can tell a great deal
about the condition of the donor. Disproportionate
numbers of white cells (leukocytes) and/or the
presence of immature leukocytes are indications
of a serious disease, as are high or low platelet
counts or misshapen red blood cells. The presence
of a high proportion of eosinophils (see figure
below) suggests a parasitic infection. Actual parasites
can be detected in blood, such as the Plasmodium species
known to cause malaria. In fact, we have observed
heartworm microfilariae (larvae) in blood samples
from pound animals.
Obviously we must use extreme caution
when handling human blood or blood products because
of the risk of transmission of the human immunodeficiency
virus (HIV). Unfortunately, the use of human blood
in teaching labs is no longer practical, although
the concerns are more about liability and insurance
rather than actual risk (love those lawyers!).
As far as we know, animal blood poses no risk from
HIV, and very few blood diseases are transmissible
from animals to humans. Laboratory bred animals
in particular pose essentially no risk at all.
Examinations should be made of freshly
collected blood samples. Whole human or animal
blood that has been treated with an anticoagulant
can be maintained under refrigeration for an extended
period of time and remain of use for research or
for clinical applications. However, after a few
hours, the white blood cells begin to clump and
to deteriorate. Some information can be obtained
after a day or two, but such smears are usually
disappointing compared to those of fresh blood.
Microscopic examination of whole
blood begins with the preparation of a smear. A
small drop of blood is placed at one end of a very
clean glass slide, and the edge of a second slide
is drawn across the drop at an angle so that capillary
action spreads the drop along the edge. The second
slide is then pushed in one smooth motion to the
opposite end of the first slide, spreading the
drop across the slide to make the smear.
After the smear has dried it can be stained by
applying a liberal amount of Wright's stain with
a pasteur pipet. Wright's stain contains red and
blue dyes that are acidophilic ('acid-loving')
and basophilic ('alkaline-loving'), respectively.
Avoid skin contact, since most stains are toxic.
The stain is allowed to remain on the slide for
about 2 minutes, and more is added if it begins
to dry up. After a short dip in buffer and/or a
rinse in deionized water, the smear is gently blotted
dry with bibulous (absorbant) paper. Incidentally,
many students have a problem with common sense
- my apologies if this insults your intelligence,
but DO remove the sheet of bibulous paper from
the book before using it for blotting. Don't simply
blot the slide onto the entire book.
Microscopic examination of formed
elements
No coverslip is needed in order to examine most smears.
A proper smear will be quite thick near the location
of the original drop and will thin out toward the
end. Using 100x bright field magnification, find
an area in which the red cells are distributed in
one layer, preferably with a slight separation between
cells, and pink in color. Darkly stained red cells
indicate that the smear was too thick, and cell shape
will likely be distorted. They should look like doughnuts,
not like stars. You may be able to see the nuclei
of white blood cells distributed among the red cells.
The nuclei stain a dark blue. Of course, the red
cells don't have nuclei.
Because mammalian red blood cells are biconcave
they will not appear as uniform disks in the microscope
field. Examination at 400x reveals them to be thin
in the center. All of the formed elements should
be examined at 1000x using the oil immersion technique
in order to make positive identifications and to
see the fine detail. The drop of oil should be
placed directly on the smear.
Most leukocytes (white blood cells) are larger
than the erythrocytes, and unless the donor had
a nasty blood disease, they will be much more scarce.
The two major categories of leukocytes are the
granulocytes and the agranulocytes, based on the
presence of visible cytoplasmic granules in one
type and the absence of visible granules in the
other. Each major type is further composed of recognizable
sub-types based on staining properties of the granules,
size of cell, and proportion of nuclear to cytoplasmic
material.
Granulocytes
Granulocytes are also known as polymorphonuclear
leukocytes, or "polys" for short. Most have irregular,
lobed nuclei. The cytoplasmic granules contain enzymes
involved in detoxification of foreign substances,
blood clotting, and various immune responses. The
neutrophil, the most common granulocyte in humans,
is so named because the cytoplasmic granules remain
unstained by acidic or basic dyes. Mature neutrophils
have a large nucleus with several lobes, although
there may be species differences. Neutrophils with
one or two lobes are immature or abnormal. The presence
of immature leukocytes can indicate a major infection,
blood parasites, or a disease such as leukemia. Neutrophils
are capable of ameboid motion under some conditions,
and as with some other leukocyte types they can accomplish
diapedesis, which is the ability to squeeze through
the pores of blood vessels to reach a chemotactic
source.
The sex of a blood donor can be determined by
examining the neutrophils. Human males have only
one copy of the X-chromosome, the genes of which
are expressed. In human females, only one X-chromosome
in each cell is expressed, while the second is
condensed, making the alleles it carries inaccessible.
The condensed X-chromosome may jut out as a very
small but obvious 'lobe' of the nucleus of the
neutrophils, called a Barr body.
Basophils and eosinophils are granulocytes with
cytoplasmic granules that stain with basophilic
(blue) and acidophilic (red) dyes respectively.
Wright-stained basophils are spectacular in appearance,
and are usually the rarest of leukocytes. Their
granules appear quite large and they stain nearly
black, often obscuring the nucleus. The eosinophils,
which are often present in large numbers in the
presence of a parasitic infection, have numerous
red-staining granules.
Agranulocytes
Lymphocytes are smaller than granulocytes, are nearly
all nucleus, and typically are nearly as common as
neutrophils. The cytoplasm can be seen as a thin
area of lighter blue between the nucleus and the
cell membrane. Lymphocytes are responsible for the
initiation of the immune response and for the acquisition
of immunity. Monocytes, the other type of agranulocyte,
are much larger than lymphocytes, with a greater
ratio of cytoplasm to nucleus. Like neutrophils,
monocytes are capable of diapedesis and can respond
to chemotactic factors by undergoing hypertrophy
(excessive growth) that converts them into macrophages.
Macrophages consume foreign substances, such as bacteria,
by phagocytosis.
Platelets
The stem cells from which red cells and leukocytes
are developed are found in the bone marrow. Also
in the bone marrow are giant cells called megakaryocytes.
Megakaryocytes disintegrate before enter the bloodstream,
so that only the fragments, called platelets, remain.
When platelets encounter a damaged surface they
swell and stick to the surface and each other to
form a plug. The plug seals blood vessels, allowing
time for the slower clotting process to take place
and form a tight seal. Platelets have no pigmentation,
and only lightly stain with Wright's stain, so
you may need phase contrast to see them.
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