Nama :………………………………

NIM :………………………………

Asessment of Peripheral Blood Morphology

NoEvaluated Aspects

Score

0 1 2 3

1Examining preparation- differentiating good and poor preparation- determining 3 parts of preparation

2Utilizing microscope in an appropriate manner- the use of objective lens is in accordance to the

condenser 3 Showing the best area for observation

4

Showing erythrocyte : the size (normocytic / anisocytosis); shape (target cell, burr cell, stomatocyte, cigar cell, etc.); staining (normochrome / hypochrome / polychromation); and immature erythrocyte (stadium).

5Determining estimation of leukocyte amount : normal/ leucocytosis/ leucopenia

6 Showing types of leukocyte (Make Differential Count)

7 Presenting leukocyte morphology

8Estimating the amount of platelet (normal, thrombocytosis/ thrombocytopenia)

9 Showing platelet morphology and its spreading.

10 Concluding the assessment result

(…./3) x10 = ………….

Note:

0 : unperformed1 : wrongly performed2 : well performed3 : perfectly performed