Comparison of anemia characterization between automated CBC analysis and conventional peripheral blood smear assessment
European Journal of Molecular & Clinical Medicine,
2022, Volume 9, Issue 2, Pages 380-388
AbstractIntroduction: Complete blood count (CBC) by the automated hematology analyzers and microscopic
examination of peripheral smears have traditionally been used in the diagnosis of anemias. The advent
of automated hematology analyzers has improved accuracy and precision of test results and has reduced
subjective errors. This study aimed at
i) Comparing anemia characterization between automated CBC analysis and conventional peripheral
blood smear assessment.
ii) Studying RBC histogram patterns in various categories of anemia.
Materials and methods: Blood samples from 500 adult anemic patients were run in Sysmex XP-100
fully automated, 3-part differential hematology analyzer. In all patients, blinded peripheral blood smear
examination by two observers was done. Anemia categorization by peripheral blood smears and
automated red cell data was compared.
Results: The number of patients with normocytic normochromic anemia on automated CBC was 280
and on peripheral smear examination was 269. On automated CBC, 137 patients had microcytic
hypochromic anemia whereas 107 patients had microcytic hypochromic picture on microscopy.
Significantly higher number (p<.05) of patients (76) with microcytic normochromic morphology was
diagnosed on blood smear compared to automated counts (17). When RBC volume and hemoglobin
content were considered together, a Kappa value of. 447 was obtained indicating moderate agreement
between the automated and manual (peripheral blood smear) assessment of anemia.
Conclusion: Patients with most anemia types can be accurately diagnosed by automated CBC analysis.
The peripheral blood smear has limitations in cases with borderline MCVs and mild hypochromia which
may be missed. It, however, still remains the cornerstone in the identification of abnormal RBC
morphology seen in hemolytic anemias.
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