Utility of automated cell counter histograms in reporting peripheral smears in anemia

Abstract

Background: Over the past few years complete blood count (CBC) by the automated hematology analyzers and microscopic examination of peripheral smear have complemented each other to provide a comprehensive report on patient's blood sample. Many times it is seen that histogram patterns show varying features when a simultaneous peripheral smear is reported. It is also seen that there are many limitations when manual peripheral smears reporting is done for example: peripheral smear reports are subjective, labor intensive and statistically unreliable. However microscopic peripheral smear examination also have their advantages. Aims and Objectives: This study was conducted to create a guide for the laboratory personnel and clinicians with sufficient accuracy to presumptively diagnose morphological classes of anemia directly from the automated hematology cell counter forms and correlate with morphological features of peripheral smear examination. Materials and Methods: The present study was undertaken in the central diagnostic laboratory at the AJIMS. 500 patients with anemia were included. 3 ml of EDTA blood sample was collected and a histogram was obtained after thorough mixing. The automated analyzer used in this hospital LABLIFE D5 SUPREME i.e. 5 part differential automated analyzer was used for the study. A simultaneous peripheral smear was also prepared according to standard operating procedures and stained by leishman stain. This peripheral smear was reported by the pathologist. Results: In the present study we noted that microcytic hypochromic anemia was the most common (72.2%) anemia. The histogram patterns correlated with the peripheral smear findings in majority cases of normocytic normochromic anemia, microcytic hypochromic anemia and macrocytic hypochromic anemia.67% histogram pattern showed left shift. 19.4% histograms showed normal curve, 11.8% showed broad base curve and 0.8% graphs showed right shift and bimodal curve. Dimorphic anemia cases showed varied patterns of histograms and required thorough examination by peripheral smears. Conclusion: Peripheral Smear examination is a sensitive and a gold standard when it comes to diagnosing red blood cell disorders. Red cell histogram patterns and the red cell indices obtained from the hematology automated analysers act as an adjunct to the visual examination of peripheral smears.