Course Content
🔬 Station 1 — Identification of Normal Blood Cells on Peripheral Smear
Learning Outcomes Identify normal RBCs, WBCs and platelets on a provided peripheral blood smear/image. Differentiate the major blood-cell lineages using their morphological features.
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Identification of Normal Blood Cells on Peripheral Smear
🔴 Station 2 — Abnormal RBC Morphology & Identification of Anemia
Learning Outcomes Differentiate normal from abnormal red blood cells on a peripheral smear. Identify common abnormal RBC shapes. Suggest the likely type of anemia from the provided RBC morphology.
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Abnormal RBC Morphology & Identification of Anemia
💊 Station 3 — Prescription Writing for Iron-Deficiency Anemia
Learning Outcomes Write an appropriate prescription for a patient at risk of developing iron-deficiency anemia. Select an appropriate iron preparation and provide clear instructions for its use.
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Prescription Writing for Iron-Deficiency Anemia
🩸 Station 4 — Safe Blood Transfusion & Recognition of Transfusion Reactions
Learning Outcomes Demonstrate the essential safety checks required before blood transfusion. Identify common transfusion reactions from a supplied clinical scenario. Describe the appropriate immediate response when a transfusion reaction is suspected.
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Safe Blood Transfusion & Recognition of Transfusion Reactions
⚪ Station 5 — Identification of White Blood Cells on Peripheral Smear
Learning Outcomes Identify the major types of white blood cells on a provided peripheral smear. Differentiate neutrophils, eosinophils, basophils, lymphocytes and monocytes using morphology. Recognize a smear demonstrating leukocytosis.
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Identification of White Blood Cells on Peripheral Smear
🔬 Station 6 — Microscopic Examination of Human and Animal Blood
Learning Outcomes Perform/interpret microscopic examination of provided human and animal blood specimens or images. Differentiate human from animal blood using the supplied microscopic features.
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Microscopic Examination of Human and Animal Blood
🔦 Station 7 — Examination of Blood Stains Under Ultraviolet Light
Learning Outcomes Demonstrate the correct approach to examination of a suspected blood stain using ultraviolet light. Recognize findings suggestive of a blood stain on the supplied material.
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Examination of Blood Stains Under Ultraviolet Light
🩸 Station 8 — Identification of Blood-Stain Patterns
Learning Outcomes Identify different blood-stain patterns from supplied specimens/images. Differentiate the presented patterns on the basis of their gross appearance.
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Identification of Blood-Stain Patterns
💉 Station 9 — EPI Vaccination, Route & Cold-Chain Assessment
Learning Outcomes Identify vaccines included in the Pakistan EPI schedule from provided material. Identify the appropriate route of administration of selected vaccines. Demonstrate/describe correct vaccine storage and maintenance of the cold chain. Recognize important contraindications to vaccination.
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EPI Vaccination, Route & Cold-Chain Assessment
🧪 Station 10 — Interpretation of Coagulation Tests
Learning Outcomes Interpret PT and APTT from provided laboratory results. Interpret bleeding time and clotting time. Use the pattern of abnormalities to identify the likely defect in hemostasis.
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Interpretation of Coagulation Tests
🩸🔬 AIM OSPE/OSCE Lab — Blood & Immunology-II Module | 3rd Year MBBS

AIM OSCE / OSPE • MBBS

Station 2 — Abnormal RBC Morphology & Identification of Anemia

Rapid Revision • Peripheral Smear Recognition • Viva

🎯 Task

CANDIDATE TASK

Examine the provided peripheral blood smear/image. Differentiate normal from abnormal red blood cells, identify the predominant RBC morphological abnormalities, and suggest the most likely type of anemia represented by the findings.

⚡ Model Station Answer
What to say in the exam

  • I would assess RBC size, colour and shape and compare them with normal red cells showing fairly uniform size and central pallor.
  • Microcytic hypochromic cells with marked anisopoikilocytosis and pencil/elliptical cells favour iron-deficiency anemia.
  • Macro-ovalocytes, particularly with hypersegmented neutrophils, favour megaloblastic anemia.
  • Spherocytes, schistocytes or sickle cells suggest a hemolytic process, while prominent target cells may suggest thalassemia or another hemoglobinopathy.

🔎 Stepwise Approach

  1. Inspect the smear systematically. If using a microscope, select the well-spread monolayer just behind the feathered edge.
  2. Establish the normal reference. Normal RBCs are relatively uniform round cells with central pallor occupying roughly one-third of the cell.
  3. Assess size. Decide whether the predominant cells are normocytic, microcytic or macrocytic; a small lymphocyte nucleus can provide a useful size comparison.
  4. Assess colour. Look for increased central pallor indicating hypochromia or unusually dense cells with absent central pallor.
  5. Assess shape. Identify characteristic forms such as target cells, spherocytes, sickle cells, schistocytes, elliptocytes/pencil cells or teardrop cells.
  6. Look at the overall pattern. Note anisocytosis, poikilocytosis and whether one abnormal morphology predominates.
  7. Correlate morphology with anemia. State the most likely anemia pattern supported by the dominant smear findings rather than naming a diagnosis from a single nonspecific cell.
Exam tip: Describe the morphology first, then give the likely anemia. Avoid jumping directly to a diagnosis without stating the visible features.

🖼️ Visual Learning

VISUAL 1

Normal vs Abnormal RBC Morphology — Peripheral Smear Recognition

 

🎥 Practical Video

High Yield Hematology: Blood Smears & Red Blood Cell Morphology
Source: Blueprint Med School

Uses peripheral-smear images to review normal RBC appearance and high-yield abnormal morphologies, helping students practise visual recognition before a hematology spotter.

▶ Watch Practical Video

📝 Important Viva Questions

Q1. What is anisocytosis?

Answer: Variation in the size of circulating red blood cells.
Q2. What is poikilocytosis?

Answer: Variation in RBC shape, with increased numbers of abnormally shaped erythrocytes on the peripheral smear.
Q3. What smear pattern is typical of iron-deficiency anemia?

Answer: Predominantly microcytic hypochromic RBCs with anisocytosis and poikilocytosis; pencil or elliptic cells may be prominent.
Q4. What morphology suggests megaloblastic anemia?

Answer: Macro-ovalocytes with anisopoikilocytosis, often accompanied by hypersegmented neutrophils.
Q5. How do you recognize a spherocyte?

Answer: It is a small, dense, round RBC with absent central pallor. It may occur in hereditary spherocytosis or immune hemolysis.
Q6. What are schistocytes and what do they suggest?

Answer: Schistocytes are fragmented RBCs, often appearing as irregular, triangular or helmet-shaped cells. They suggest mechanical or microangiopathic red-cell destruction.
Q7. Which RBC shapes are particularly associated with hemoglobin disorders?

Answer: Sickle cells strongly suggest sickling disorders, while prominent target cells are commonly seen in thalassemia and other hemoglobinopathies.
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