How to make a blood smear
The full blood count (OER from Dr Frances Mullen at Queens Belfast University)
Automated blood analysis (OER from Leicester Royal Infirmary)

Sickle cell OERs (genetics, histology, nursing and social sciences)


TITLE: PERFORMING A BLOOD SMEAR

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Video and narration by biomedical scientist from the Leicester Royal Infirmary.

"When you see something that isn’t supposed to be there it is absolutely fascinating."

Making blood films is an integral part of haematology. By analysing films we can look at patients blood via a microscope. This helps us to distinguish whether they have an abnormality – for example leukaemia, mal, sickle cell disease or any other abnormalities we can physically see with our eyes. Analysers provide us with data but this helps us look at cells. One the blood films have been made they need to be stained so they can be looked at down a microscope using colours. What we use is simple stains, which uses acids and alkaline so the H&E are basic components of any staining.

Won’t you do a Giemsa? This is a modified Wright’s stain. The Giemsa we use for bone marrow. This is part of Giemsa anyway. You get a reddish pinkish colour for blood cells and blue colour for nuclei.

A manual technique so more experience is required to make blood films because dangers are involved when spreading blood films. We do have an automated analyser (but it isn’t working). Films are fixed in methanol and stained on flat bed stainer. We’ve also got another stain Other stain is Diff-Quik which is a quick stain to help distinguish malaria or malarial parasites. By legal requirements (the lab) needs to do two separate techniques to look at malaria. Some places use thick and thin films. We don’t. Modified Wright’s and Diff-Quik (differential).

How many are made in one day? Approximately 200-300 films – a lot of man power and more man power to look at them. As a biomedical scientist in haematology, morphology is the integral part because you’ll be authorising reports and morphology is the last of tests to be performed. If you make a mistake there which causes consequences – it is important that the morphology you have the experience to do it – takes a minimum of 2 years post-registration experience. You also get constant competencies checked where you have internal qualities you need to identify, and external quality schemes. If you get any problems there you have to go back on your training which isn’t very often because of the experience that you gain.

Leicester is such a vast ethical diversity within the population we are so lucky we see a huge amount of films. We do see malarias. We see thalassaemias. We see so many leukaemia, neonatal blood films and renal patients. One of the most interesting parts of haematology is the morphology because it puts all of your teachings and experience into a seal. So the morphology is I would say the most difficult to grasp but the most important, challenging and rewarding.

When you see something that isn’t supposed to be there it is absolutely fascinating.

Micro-filarial patients – worms – rare – but when you see that it is an achievement and in my 15 years in the lab I have only seen one micro-filarial worm and that was by chance.

Trainees will get hands on looking down a microscope but they will not get to authorise reports.

 


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