Why Erythropoietin Matters
Red cells were one of the first things to be recognised and studied when the microscope was first developed. These cells have a key role…
Author: Dr Ali Mahdi
The Essentials of Pre-Transfusion Testing
The blood bank has a vital role in the running of any hospital. Blood is essential to a whole range of clinical scenarios. Think of patients with majo…
Apheresis: what you need to know
Therapeutic apheresis is the withdrawal of whole blood from the body, separation of one or more components, and return by transfusion of remaining blo…
The Mysteries of the Coagulation Collection Tube and Anticoagulant
Errors in sample collection and processing are costly although often preventable. Getting it right is vital for the patient.
Why counting plasma cells matters
For anyone who treats haematological malignancies, myeloma is a challenging disease to tackle. It remains incurable with a relapsing-remitting patter…
Case Study – Diagnosis of COVID-19 Vaccine Associated Thrombosis and Thrombocytopenia (VATTS)
A 39 year old male presented to A&E with shortness of breath, the patient had been feeling lethargic, generally unwell and short of breath for several…
The Blood Smear – A Story Writing Exercise
Our blood carries so much all over our body. It is truly a reflection of how well or how badly we are doing. Doctors everywhere…
You see it under a low magnification to get a sense of where you are, just like a drone footage of the first scene of your story. You find the right spot for further examination- not too thick, not too thin- somewhere between the tail and the body. You do not want too much of a crowd, our characters can get lost. Once you decide on the perfect Goldilocks spot, you zoom in. 
You, the author, have just set the scene. Now we meet the characters. Every character has a backstory, where they came from right up to when we meet them. To properly understand the length and depth and width of their character we need to elaborate on their two aspects- a quantitative one, and a qualitative one. In blood, there are three main characters- red blood cells, white blood cells and platelets, and each one deserves their quantitative and qualitative description. First up, the red blood cells. Erythrocytes. Without them, our tissues would starve for oxygen and die. Without them, we would lose all pink colour- from our mucus membranes and peripheral smears. Let us begin with their quantitative description- how many are they, and how are they arranged. 
Now let us describe them qualitatively. What is their size, their shape, their colour? Remember, variety is the spice of life- sprinkle it! Mention the poikilocytes (differently shaped RBCs) seen. And if everything looks so varied that you see different shapes and sizes- that’s anisopoikilocytosis for you! 
All of this was an external description but let us really get into the heart of these characters. Look inside, literally. See if there are any inclusions in the RBCs. 
Now, let us move on from the reds to the whites. Leucocytes. These cells are the army, both defensive and offensive. This army has five units- neutrophils, lymphocytes, monocytes, eosinophils, and basophils-each with their own targets but also the capacity to team up in case something is wrong. The genre of your story has just become “action”- with violence, and a lot of collateral damage. First, quantity. Are the cells more? If yes, which kind is more? Each one in abundance has a different story. Where there’s fighting, there is good vs evil. Look closely to make out if all in the army look like heroes or some villains have crept in. Identify and describe any atypical forms, if present. Look closely at the nuclei and cytoplasm separately and see if anything looks different. 
Your story is really taking shape, isn’t it? From the passionate red cells to the combative white cells, let us now turn our attention to the quiescent platelets. Underrated but oh so vital! Take in their number, see how they are distributed, before moving to describing their size and colour. 
Let us shake up the genre once more and look for aliens! There might be something lingering, swirling or just sitting in the peripheral smear that should not be there. Yes, you are right. I am talking about hemoparasites. Look both inside and outside cells. Go back to the drone footage again, see if something pops up. Look between cells and in them, especially red blood cells- passion attracts trouble, does not it! 
Once you have written all your relevant findings, now summarize them. Who do you think was the main character? Or is it an ensemble cast? Is it just anemia, or anemia with leukemia? Is it just thrombocytopenia, or a possible microangiopathic hemolytic anemia lurking too? Let the reader (patient and the consulting clinician) know what to expect from this story. Congratulations, you are now a storyteller. Keep writing.