A comparative study of anemia in peripheral blood smear and automated cell counter generated red cell parameters

BACKGROUND: Complete blood count and cell counter generated red blood cell (RBC) parameters help in morphological typing of anemia. Still the importance of microscopic examination of peripheral blood smears (PBSs) cannot be excluded to interpret the cause of anemia. AIMS AND OBJECTIVES: The present study was done to diagnose the type of anemia by examination of PBS and automated cell counter generated parameters and to compare the findings between these two methods. MATERIALS AND METHODS: During the 6-months study, 9981 anemic blood samples were evaluated. PBS findings and cell counter generated RBC parameters and histograms were evaluated and compared. RESULTS: Among 9941 samples, microcytic hypochromic anemia consists of the majority of cases (5048, 50.47%), followed by normocytic normochromic (2187, 21.97%), dimorphic (1297, 12.99%), and lastly, hemolytic anemia (722, 7.24%). Compared with RBC parameters and peripheral smear findings, dimorphic and hemolytic anemia showed significant difference (P < 0.0001). When compared with RBC histogram, 4747 (47.56%) cases showed left shift, 820 (8.21%) cases showed right shift, and 2278 (22.82%) cases showed normal bell-shaped curve suggesting microcytic, macrocytic, and normocytic normochromic anemia, respectively. 635 (6.90%) and 1447 (14.50%) number of cases showed bimodal and broad-base histogram suggesting dimorphic and hemolytic anemia, respectively. CONCLUSION: PBS examination along with RBC histogram study can be able to categorize the type of anemia in the majority of cases. Each method should be used as complementary to each other that increases diagnostic accuracy.