Hello everyone, how are you all? hope you all are doing well and i am too. Today i would like to tell about an important screening test and its called Sickling test and sickle cell disease how they look in peripheral smear.
we have heard hemoglobinopathies and have seen in our life. examples include sickle cell anemia, thalassemia major and minor etc... these are most common hemoglobinopathies that are commonly seen.
Sickling test is only used for sickle cell anemia suspected cases.
In sickle cell anemia, the red blood cells become sickle shaped and this is because of single base-pair point mutation in the β-globin gene and resulting in replacement of glutamic acid by valine in the 6th position of beta globin chain.
Whenever a patient comes to hospital, the basic investigation advised to find out hematology related diseases or disorder is complete blood picture and then peripheral smear examination.
Case
A 6 year old girl child came to hospital for dizziness and weakness. Patient looks pallor and Complete blood picture and peripheral smear examination was advised. Then HB was 8 g/dl. The peripheral smear on examination showed these findings.
Peripheral smear findings
There is abnormality found in the morphology of red blood cells. Normocytic normochromic RBCs along with Microcytic hypochromic RBCs, polychromatophils, target cells and few characteristic sickle shaped cells with pointed ends on either side is noted. Few nucleated RBCs also seen. WBCs and platelets are within normal range and shows normal morphology. No parasite was found.
So i suspected it should be hemolytic disorder and mostly it could be a sickle cell disease.
So i advised screening test which is named as sickling test. Then sickling test was done and it showed like this.
Sickling Test
The black color round labelling represents sickle shaped cells.
To avoid confusion i will share normal RBCs also how it looks like after sickling test.
You can see RBCs are round in shape which is normal and they are in contrast in morphology compared with sickle cell disease.
We will advise HPLC(High Performance Liquid Chromatography) for again confirmation. It is also screening test.
The ultimate gold standard diagnosis is genetic studies and parental screening.
As this disorder hereditary family history is important.
To diagnose sickle cell disease is important because ppl will get treatment which is blood transfusion and for sickle cell trait there is no need of blood transfusion as patient is asymptomatic. The patients also gets pension(money) from government to compensate their needs during management.
References
- Haemoglobinopathy Diagnosis Barbara J. Bain MBBS FRACP FRCPath Third edition
- Dacie and Lewis Practical Haematology, Twelfth edition
I hope you understood something today.
Thanks for reading,
with regards,
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