A peripheral blood smear is shown below. Which supravital stain was used?

INI-CET EXAM -2026

Pathology & Genetics

Easy

Appeared in: INI-CET EXAM -2026

Explanation

New Methylene Blue is a supravital stain, meaning it is applied to living, unfixed cells.
This stain penetrates immature red blood cells (reticulocytes) and precipitates the residual ribosomal RNA (rRNA) within them.
The precipitated rRNA forms a characteristic dark blue, net-like structure or 'reticulum', which is visible under a microscope and allows for identification and counting.
The image clearly shows these reticulocytes with the classic stained reticulum, confirming the use of a supravital stain like New Methylene Blue.

Option A: Giemsa stain is a Romanowsky-type stain used for fixed smears to differentiate white blood cells and detect blood parasites like malaria. It does not visualize the reticulum in reticulocytes.
Option C: Leishman stain is another Romanowsky stain, similar to Giemsa. It is used for differential white blood cell counts and to visualize parasites like Leishmania. It does not stain the reticulocyte network.
Option D: Diff-Quik is a rapid, modified Romanowsky stain used for quick differential counts in clinical settings. Like other Romanowsky stains, it does not reveal the specific reticulum of reticulocytes.

Clinical Relevance

Nursing practice connection: Knowing Identification of supravital stains for reticulocyte visualization helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
The reticulocyte count is a fundamental nursing assessment tool to understand the bone marrow's response to anemia. It helps differentiate between anemias caused by poor production versus those caused by increased destruction or loss of red blood cells.
A nurse monitoring a patient receiving treatment for iron-deficiency anemia (e.g., iron supplements) would expect to see a rising reticulocyte count as an early sign that the treatment is effective and the bone marrow is starting to produce more RBCs.
What if? If the smear showed single, eccentric, dark blue dots (not a network) after supravital staining, these would be Heinz bodies. This would shift the diagnosis towards conditions causing oxidative stress on RBCs, such as G6PD deficiency or exposure to certain drugs/toxins.

How to Approach the Question

First, carefully examine the image provided. Note the presence of red blood cells containing a distinct blue, web-like or granular pattern inside.
Identify these specific cells as reticulocytes, which are immature red blood cells.
Read the question stem, which asks to identify the 'supravital stain' used. This term is a major clue, as it refers to a specific category of stains used on living cells.
Connect the visual finding (reticulocytes) with the key term (supravital stain). The task is to find the specific supravital stain used to visualize reticulocytes.
Evaluate the options. Recall or deduce that New Methylene Blue is the classic supravital stain for this purpose. Giemsa, Leishman, and Diff-Quik are Romanowsky stains used for different purposes on fixed smears.

Concept Tested & Keywords

Concept Tested: Identification of supravital stains for reticulocyte visualization.
Stem keywords: peripheral blood smear, supravital stain
Lead-in keywords: Which
Clinical cues: Image showing reticulocytes with a distinct reticulum.

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E6 Medicine Harrison 22e Part 1 pp. 478-480, 488-490

E6 Pathology-Vandana Puri & Kavita Gaur Textbook of Pathology and Genetics p. 389-391