Study of Automated Red Blood Cell Parameters in Correlation with Routine RBCs Morphology by Smear Review

Abstract

Since the first use of automated analyzers, microscopic examination of a stained blood film has complemented analyzer results to provide a comprehensive hematology report on a patient's blood sample. Despite improving capabilities of automated hematology analyzers, manual slide review is still necessary to identify some morphologic abnormalities that may be relatively unremarkable in automated methods. Owing to the fact that manual microscopic examination of the blood smear is subjective, time consuming and due to the incompleteness of accurate morphological information on individual RBCs from hematology analyzers, our study was designed with the aim of comparative evaluation of RBCs morphology under microscope and RBCs parameters from Sysmex xt1800 analyzer in the main laboratory of Ain Shams University Hospital. The study samples were routine inpatient and outpatient samples from all departments of Internal Medicine Hospital with the exception of pediatric samples. 200 blood samples were selected randomly from the daily workload over a period of 4 months. Automated CBC were performed using Sysmex XT 1800. Blood films were done for all samples and were reviewed for RBCs morphological abnormalities. Among the 200 samples, about 49.5% had abnormal RBC morphology. 50% of cases had normocytic RBCs, 47% were microcytic and 3% were macrocytic. Normochromic samples represented 66% of cases, hypochromic samples represented 34% and anisocytosis was detected in 76.5% of samples. The three most common findings of abnormal RBC morphology were acanthocytes (19%), ovalocytes (10.5%) and schistocytes (5%), all of which cannot be detected by the device and only evaluated by smear review.