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Year : 2022  |  Volume : 13  |  Issue : 2  |  Page : 110

Unexpected finding of endothelial cells in peripheral blood smear

Department of laboratory and blood bank, King Fahad Central Hospital, Jazan, Saudi Arabia

Date of Submission28-Sep-2020
Date of Decision12-Dec-2020
Date of Acceptance16-Jan-2021
Date of Web Publication04-Aug-2022

Correspondence Address:
Dr. Qasem Ibrahim Alneami
King Fahad Central Hospital, Jazan
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/joah.joah_183_20

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How to cite this article:
Alneami QI. Unexpected finding of endothelial cells in peripheral blood smear. J Appl Hematol 2022;13:110

How to cite this URL:
Alneami QI. Unexpected finding of endothelial cells in peripheral blood smear. J Appl Hematol [serial online] 2022 [cited 2023 Sep 30];13:110. Available from: https://www.jahjournal.org/text.asp?2022/13/2/110/353274

The peripheral blood smear is one of the best and valuable means of investigation in laboratory hematology.[1]

There are several indications for requesting a peripheral film by the physician that helps in establish a reliable and definitive diagnosis or include or exclude one of the differential diagnoses, depending on the patient's clinical data and correlation with other ancillary study findings.[2]

The following microscopic pictures were taken from a peripheral blood film of a patient presented with erythrocytosis. The morphology of peripheral blood smear was unremarkable; however, at the tail of the blood smear, there is a cluster of cells [Figure 1]a and [Figure 1]b, which are medium to large in size with a round-to-oval nuclei, some they display nuclear grooving, and they do have a moderate to a large amount of pale-blue cytoplasm.
Figure 1: Wright stain; a, ×200; b, ×1000

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Endothelial cells are normal inner lining layers of the blood vessels unexpectedly seen in peripheral blood films and rarely shed due to the sharp cutting-edge needles used for venepuncture.[3],[4]

Expanded number of endothelial cells can be seen in a wide variety of conditions that are associated with either vascular damage or accelerated new blood vessel formation ranging from benign and reactive events to malignant diseases.[5]

Due to the rarity of this finding and clustering of these cells, it might be confused with circulating malignant cells, especially in cases where the history and clinical findings are suspicious to be malignant. Moreover, EPO can stimulate new blood vessel formation by expression and upregulation of vascular endothelial growth factor and its receptor, which is a very crucial growth factor for vascular endothelial cells and robust angiogenic factor.[6]

The aforementioned findings might be considered as a new condition associated with an increased number of endothelial cells and hence their presence in the peripheral blood smears.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Barth D. Approach to peripheral blood film assessment for pathologists. Semin Diagn Pathol 2012;29:31-48.  Back to cited text no. 1
Bain BJ. Diagnosis from the blood smear. N Engl J Med 2005;353:498-507.  Back to cited text no. 2
Shanberge JN. Accidental occurrence of endothelial cells in peripheral blood smears. Am J Clin Pathol 1955;23:460-4.  Back to cited text no. 3
Li JG, McLaughlin RF, Wellings SR. Endothelial cells in blood smears. Calif Med 1958;89:22.  Back to cited text no. 4
Cha CH, Kim JU. Endothelial cells in peripheral blood smear: An artifact? Korean J Hematol 2010;45:150.  Back to cited text no. 5
Kimáková P, Solár P, Solárová Z, Komel R, Debeljak N. Erythropoietin and Its Angiogenic Activity. International journal of molecular sciences 2017;18:1519.  Back to cited text no. 6


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