Red blood cell histogram in different morphological types of anemia in comparison with peripheral blood smears: A comparative analysis

Abstract

Background: Anemia is a significant health concern around the world, and it is particularly prevalent in developing nations like India. A red blood cell (RBC) histogram is a graphic representation of particle size distribution (cell frequencies vs size). The goal of this study was to examine various types of anemia in patients and compare RBC histograms and results from peripheral smears. Methods: The study involved a total of 600 anemic patients. A histogram was produced with the use of a 5-part differential automated analyzer, following the complete mixing of the 3 mL of the EDTA blood sample. Additionally, a peripheral smear was prepared simultaneously and stained using Giemsa stain per standard operating procedures (SOP). The peripheral smear findings were then correlated with the histogram charts from the cell counter, taking into account the relevant clinical history. Results: Out of 600 cases, 339 were females, with a female-to-male ratio of 1.3:1. The 56.2% showed moderate anemia, 31.3 % showed mild anemia, and 12.5 % showed severe anemia. Among the histogram patterns, 52.7% exhibited a left shift, 35.5% showed the normal curve, 8.6% showed a broad base curve, 1.8% showed a right shift, and 1.3% showed a bimodal curve. Blood samples were evaluated along with the corresponding peripheral smear findings. The type of anemia was diagnosed by peripheral smear. 32.8 % of the cases were normocytic normochromic anemia, and 57.0% were microcytic hypochromic anemia. Macrocytic anemia was observed only in 2.5 % of cases, and dimorphic anemia was observed only in 8.0 % of cases diagnosed with PBS. The majority of times, peripheral smear findings and histogram patterns corresponded in cases of normocytic normochromic, microcytic hypochromic, and macrocytic anemias. In 600 cases, 420 had typing findings that accorded with those of the 2 methods, while 180 had discordant typing. Conclusion: Through its graphical representation of anemia typing, the automated analyzer helps decrease the total burden; nonetheless, it should always be verified through microscopy. As a result, it is concluded that in the era of molecular analysis and automation, the histogram alone could be used as a screening method. When combined with PBS findings, they act as a useful supplement, and by correlating the results of both methods, we could diagnose the majority of anemias.

Keywords

• anemia
• haemoglobins
• peripheral blood smear