COMPARATIVE STUDY OF AUTOMATED CELL COUNTER HISTOGRAM AND PERIPHERAL BLOOD SMEAR IN DIAGNOSIS OF ANEMIA

Introduction: Over the past few years, complete blood count, RBC histogram and peripheral blood smear have become the important diagnostic tools to diagnose various haematological conditions. Major public health burden worldwide is anemia with high prevalence in developing countries like India1. Red blood cell and histogram are indispensable for diagnosis and management of anemia2. The major diagnostic tool for work up of most commercial laboratories has been analysing the blood film routinely. The aim AIM: of the study is to compare between automated cell counter histogram and peripheral smear finding in diagnosis of anemia. Material and method: A prospective comparative study of RBC histogram and peripheral blood smear in diagnosis of anemia was done on 100 patients of HB<14gm%, over six month time span (June2022-Nov2022) in the central laboratory of Saraswathi Institute of Medical Sciences Hapur, (UP) India. This study included all the age groups. All cases of anemia that have undergone blood transfusion is excluded from this study. In Result: our study it was observed that on peripheral blood smear, the most common type of anemia was microcytic hypochromic anemia followed by normocytic normochromic anemia, when we compared with automated cell counter generated histogram most common type of anemia was normocytic normochromic followed by microcytic hypochromic anemia. In our study female population were more than males. The mean age was(32.4yr). Automated cell counters generated CBC histograms and peripheral blood smears Conclusion: plays a major role in diagnosis and management of red cell disorder. Our study observed that histogram patterns and their confirmation by peripheral blood smear along with clinical history gives accurate and confirmed diagnosis of various haematogical conditions. There is much improvement in accuracy and precision 3 reducing the subjective errors .

The Phenomenon of the ‘Starry Sky’ on Blood:Lesson Learned From Severe Malaria Falciparum

Severe malaria occurs when previously uncomplicated malaria infections are then turn to be full blown and tangled by serious, single or multi-organ failures or abnormalities in the patient's blood or metabolism. Clinical deterioration can happen abruptly and unnoticed, due to the masking of other prominent clinical condition like hyperthermia. Making the correct diagnosis as soon as possible is pivotal before administering antimalarial therapy. Diagnosis is made by examining the thick and thin blood films in an attempt to find malaria parasites in the blood sample.The “Starry Sky” appearance is a microscopic feature of severe malaria infection and its exclusively found only in thick blood film. The aim of this minireview is to discuss about theclinical background of“Starry Sky”appearance found in thick blood smear of severe malaria and its brief review combined with our experience in the Deptartment of Parasitology, Faculty of Medicine Universitas Kristen Indonesia, Jakarta-Indonesia, inhandled blood test from a vulnerable patient with severe malaria and how we pass on the lessons from that story to our students as part of health communication in community based Parasitology. By inserting this story to our lesson materials, we hope can build awareness among our students as future health practitioners and also to the publicthey serveas well as all stake holders; this snow ball action are currently and continously requiredto be done

A telepathology based screening tool for COVID-19 by leveraging morphological changes related to leukocytes in peripheral blood smears

As we approach the aftermath of a global pandemic caused by Severe Acute Respiratory Syndrome-Corona Virus (SARS-CoV-2), the importance of quickly developing rapid screening tests has become very clear from the point of view of containment and also saving lives. Here, we present an explorative study to develop a telepathology-based screening tool using peripheral blood smears (PBS) to identify Coronavirus Disease (COVID-19)-positive cases from a group of 138 patients with flu-like symptoms, consisting of 82 positive and 56 negative samples. Stained blood smear slides were imaged using an automated slide scanner (AI 100) and the images uploaded to the cloud were analyzed by a pathologist to generate semi-quantitative leukocyte morphology-related data. These telepathology data were compared with the data generated from manual microscopy of the same set of smear slides and also the same pathologist. Besides good correlation between the data from telepathology and manual microscopy, we were able to achieve a sensitivity and specificity of 0.83 and 0.71, respectively, for identifying positive and negative COVID-19 cases using a six-parameter combination associated with leukocyte morphology. The morphological features included plasmacytoid cells, neutrophil dysplastic promyelocyte, neutrophil blast-like cells, apoptotic cells, smudged neutrophil, and neutrophil-to-immature granulocyte ratio. Although Polymerase Chain Reaction (PCR) and antibody tests have a superior performance, the PBS-based telepathology tool presented here has the potential to be an interim screening tool in resource-limited settings in underdeveloped and developing countries.

Smudge cells percentage on blood smear is a reliable prognostic marker in chronic lymphocytic leukemia

Abstract Objective We evaluated the relevance of using the smudge cell percentage in the blood smear as a prognostic marker in CLL. Methods In this prospective study, 42 untreated Senegalese patients with CLL were enrolled. The diagnosis was established, based on the peripheral blood count and flow cytometry using the Matutes score. Cytogenetic aberrations, assessed by fluorescence in situ hybridization (FISH), were available for 30 patients, while the immunoglobulin heavy chain genes (IGVH) mutation status was performed by next-generation sequencing (NGS) in 24 patients. The SC percentage was determined in the blood smear, as previously described. Statistical analyses were executed using the GraphPad Prism 8. Results The mean age was 63 years (48 - 85) and the male: female sex ratio was 4.66. A low SC (< 30%) percentage was correlated with Binet stage B/C (p= 0.0009), CD38 expression (p= 0.039), unmutated IGVH status (p= 0.0009) and presence of cytogenetic abnormalities (for del 13q, p= 0.0012, while for other cytogenetic aberrations, p= 0.016). An inverse correlation was found between the SC percentage and the absolute lymphocyte count (r= -0.51) and patients with higher percentage of SCs had a prolonged survival. However, there was no correlation between the SC percentage and age (p= 0.41) or gender (median, 19% for males vs. 20% for females; p= 0.76). Conclusion When less than 30%, the SC was associated with a poor prognosis in CLL. Easy and affordable, the percentage of SCs in a blood smear could be a reliable prognostic marker, accessible to all CLL patients, mainly those in developing countries.

Comparison of peripheral blood smear and automated cell counter in 100 cases of anemia

Background: Hemogram/ Complete Blood Count (CBC), performed on hematology analyzers, is one the most commonly ordered blood test in clinical practice especially in patients presenting with fever. The aim of the present study was to compare accuracy of RBC histograms shown by our 5 part cell counter to that of microscopy examination of blood film stain by field stain. Materials and methods: The present observational study was conducted during June 2020 - August 2020. Samples were run on 5 part hematology analyzer. Population of both anemic and healthy individuals in the age group 0-60 years were evaluated for the study. Total 100 patients in the age group of 0- 60 years were enrolled in this study. Hematological parameters were obtained by using 5 part automated hematology cell counter. The hemoglobin concentration and red blood cell (RBC) indices, encompassed mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) and erythrocyte count. Results: We studied 100 blood samples of patients. Among them 82 cases showed correlation between histogram to that of the peripheral blood smear examination.Conclusion: The result of the study shows that the automated hematology analyzer are appropriate for screening purposes because it increases the turnaround time and reduces the labor cost. But to diagnose and differentiate different types of anemia manual scan of peripheral smear is a method of choice.

Application value of the modified blood smear technique for platelet counting / 中国基层医药

Objective:Four methods were used to count platelets to recommend suitable retest methods for abnormal blood platelet count.Methods:A total of 300 patients who received treatment in the Second People's Hospital of Lianyungang during August-September 2020 were included in this study. They were divided into low-value, median-value, and high-value groups ( n = 100/group) according to blood platelet counts determined by the electrical impedance method. The consistency in blood platelet counting was analyzed between flow cytometry and electrical impedance method, Neubauer chamber method, and modified blood smear method. Results:There was no significant difference in blood platelet count between the electrical impedance method [low-value group: (86.1 ± 10.3) × 10 9/L, median-value group: (221.8 ± 41.8) × 10 9/L, high-value group: (441.3 ± 51.4) × 10 9/L, Neubauer chamber method [low-value group: (85.2 ± 10.1) × 10 9/L, median-value group: (219.3 ± 37.7) × 10 9/L, high-value group: (443.1 ± 54.5) × 10 9/L, modified blood smear technique [low-value group: (86.1 ± 10.1) × 10 9/L, median-value group: (218.1 ± 37.7) × 10 9/L, high-value group: (442.6 ± 53.3) × 10 9/L], and flow cytometry [low-value group: (85.4 ± 10.1) × 10 9/L, median-value group: (220.7 ± 42.0) × 10 9/L, high-value group: (440.9 ± 50.0) × 10 9/L] (all P > 0.05). The Bland-Altman analysis revealed that the electrical impedance method, Neubauer chamber method and modified blood smear method, and flow cytometry showed consistency in blood platelet count. Conclusion:The modified blood smear method showed consistency with the electrical impedance method, Neubauer chamber method, and flow cytometry in blood platelet counting. It does not require a special instrument and can help observe cell morphology for blood platelet counting. In addition, the blood smears are easy to be preserved. The modified blood smear technique should be the first choice for re-checking blood platelet counts.

Detection of Leishmania infantum amastigotes in neutrophil from peripheral blood in a naturally infected dog / Detecção de formas amastigotas de Leishmania infantum em neutrófilos do sangue periférico de cão naturalmente infectado

Abstract Canine visceral leishmaniasis (CVL) is a zoonotic disease of high lethality caused by Leishmania infantum in the Americas. In the infected dog, the amastigotes are scarce in blood, especially in the late phase of the disease. This study aimed to report a rare case of L. infantum amastigotes found in neutrophils from peripheral blood of a naturally infected dog in terminal phase of CVL, also describing its clinical status before and after treatment with miltefosine 2%. The dog, which presented as polysymptomatic and with classical signs and symptoms of CVL was submitted to the following tests: Dual Path Platform (DPP) rapid test, ELISA and parasitological examination of peripheral blood. Hematological and biochemical parameters were obtained before and after treatment. All diagnostic tests were positive for CVL. The identification of L. infantum amastigotes inside neutrophils from peripheral blood was confirmed through microscopy, and the species was confirmed by molecular analysis. At the end of the treatment, peripheral parasitemia was not detected, and improvements were observed in clinical and laboratorial parameters. Finally, this atypical finding can be used as example to raise discussions about the real immunological role of neutrophils in late phases of CVL and its clinical/therapeutic implications.

Resumo A leishmaniose visceral canina (LVC) é uma doença zoonótica de alta letalidade causada por Leishmania infantum nas Américas. No cão infectado, as formas amastigotas são escassas no sangue, principalmente na fase tardia da doença. Este estudo teve como objetivo relatar um caso raro de amastigotas de L. infantum encontradas em neutrófilos do sangue periférico de um cão naturalmente infectado e terminal da LVC, descrevendo também seu estado clínico antes e após o tratamento com miltefosina a 2%. O cão, que se apresentou como polissintomático e com sinais e sintomas clássicos da LVC foi submetido aos seguintes testes: teste rápido Dual Path Platform (DPP), ELISA e exame parasitológico de sangue periférico. Os parâmetros hematológicos e bioquímicos foram obtidos antes e após o tratamento. Todos os testes diagnósticos foram positivos para LVC. A identificação de formas amastigotas de L. infantum, dentro de neutrófilos do sangue periférico foi confirmada por microscopia, e a espécie foi confirmada por análise molecular. Ao final do tratamento, não foi detectada parasitemia periférica, observando-se melhora dos parâmetros clínicos e laboratoriais. Por fim, esse achado atípico pode ser usado como exemplo para levantar discussões sobre o real papel imunológico dos neutrófilos nas fases tardias da LVC e suas implicações clínicas/terapêuticas.

Comparison of platelet count by manual and automated method

Background: Since the emergence of dengue fever in the past few years, platelet count has become a routine test in every pathology lab. Common methods are by peripheral blood smears made from blood collected in ethylenediaminetetraacetic acid (EDTA) tubes, by neubaeur chamber, automated method by hematology cell counter.Methods: Blood samples of 460 adult patients and 72 children (<15 years), including indoor and outdoor, between May to August 2019, attending Hind institute of medical sciences, were collected in EDTA tubes. Samples were properly mixed on blood shaker and immediately peripheral blood smears were made and stained with Leishman stain. Platelet count of every sample was done by peripheral blood smear and by Mindray (BC5150) automated cell counter, simultaneously.Results:  Results by manual slide method are slightly higher than automated method but significantly not different from automated method.Conclusions: Traditional slide method can also be used if done carefully comparable to automated method especially useful in small labs which can’t afford automated cell counter.

Is this a blast? An illustrated practical review on peripheral blood smear examination in the paediatric patient

@#The morphologic findings on a peripheral blood smear can provide important clues that help establish a diagnosis or guide the workup of many clinical disorders. Finding a blast – whether clinically expected or not – is one of the most impactful of such findings. Pathologists, clinical haematologists, technologists, and trainees in the medical field often feel the need to refer to an illustrated reference when encountering suspected blasts and blast-mimics. This article provides a practical concise resource that demonstrates the morphological features of the various types of blasts and illustrates the cytologic characteristics that help distinguish them from their benign mimickers in the paediatric population.

Quality of malaria blood smears from fever patients in Zibo City, Shandong Province from 2011 to 2018 / 中国血吸虫病防治杂志

Objective To analyze the quality of malaria blood smears from fever patients in Zibo City from 2011 to 2018, so as to provide the scientific evidence for the development of the malaria post-elimination surveillance strategy. MethodsAll negative malaria blood smears from fever patients reexamined in the municipal microscopic examination station and all positive blood smears in Zibo City during the period from 2011 to 2018 were reexamined, and the blood smear preparation, dyeing, cleanliness and reexamination results were analyzed. Results A total of 2 141 negative malaria blood smears and 39 positive blood smears were re-reviewed by the municipal microscopic examination station of Zibo City from 2011 to 2018, with a 99.44% qualification rate of negative blood smears preparation, a 97.62% qualification rate of dyeing, a 93.65% qualification rate of cleanliness, and a 100% consistence with the re-review, and no missing diagnosis was found. A total of 39 positive blood smears were re-reviewed, with a 46.15% qualification rate of blood smears preparation, a 61.54% qualification rate of dyeing, a 76.92% qualification rate of cleanliness, and a 97.44% consistence with the re-review, and a blood smear mistaking the Plasmodium species was found. There were significant differences in the qualification rate of blood smears preparation and dyeing among all districts (counties) in Zibo City (all P values < 0.05), and no significant difference was detected in the qualification rate of blood smear cleanliness (χ2 = 13.72, P >0.05), while significant differences were seen in the qualification rate of blood smears preparation, dyeing and cleanliness each year from 2011 to 2018 (all P values < 0.05). Conclusions The quality of malaria blood smears is high in all districts of Zibo City; however, the quality of city-level blood smears remains to be improved. Further actions to improve the training of grassroots microscopic examinations and quality control of malaria blood smears are required to ensure the capability of microscopic examinations of Plasmodium during the malaria post-elimination stage.

Estimation and comparison of thrombocyte count by peripheral blood smear method and automated method in women with pregnancy

Background: Thrombocyte is important and very essential component of blood and have significant role in maintenance of hemostasis. Thrombocyte count is an important investigation done in various acquired and congenital coagulable states which include conditions like pregnancy. Thrombocyte count is routinely done by automated hematology analyzer method. The automated hematology analyzer counters are not usually available at all centres especially in peripheral and rural side though thrombocytes can also be assessed from the peripheral blood smears, which can be easily and precisely done at any set up. Aim and objective of this study was to compare the thrombocyte estimation by peripheral blood smear method and automated hematology analyzer in pregnant women.Methods: Thrombocyte estimation was done from samples taken from 120 normal pregnant women between December 2018 to March 2019, where samples were Ethylene Diamine Tetra Acetic acid (EDTA) anticoagulated. Thrombocyte was counted manually using PBS (Leishman stain) and hematology analyzer (Sysmex XN1000 series). Thrombocyte counts were expressed in Mean and standard Deviation. Statistical analysis was done by student’s t test using MS excel and SPSS version 17.Results: Thrombocyte count by PBS have mean value of 2.04 lacs/mm3 with standard deviation of 0.56 lacs/mm3 and by automated method have mean value of 1.89 lacs/mm3 and standard deviation of 0.71 lacs/mm3 with p value 0.010. Thus, there was no statistically significant difference found between two methods.Conclusions: Estimation of thrombocyte count on the basis of manual thrombocyte count is a reliable technique and can be used to validate automated thrombocyte counts. It can also be used in under resourced laboratories, where there are no automated counters of good precision available. In fact, all the tests showing abnormal thrombocyte counts must be reported only after cross examining on PBS.

A study on reliable diagnosis of allergic respiratory diseases by using eosinophil count in nasal and blood smear: a prospective study in tertiary care centre

Background: Allergic rhinitis and asthma are two very common allergic diseases of respiratory tract in pediatric patients. In this geographical area, where the prevalence of allergens exists, the role of allergens as the etiological factor is higher in allergic respiratory disorders. Confirmation of allergen as etiologic agent is cumbersome in a small setup, where IgE estimation and allergy tests are not accessible. In this study, the simple test of peripheral smear and nasal smear eosinophil count as a reliable diagnosis to solve the above problem and establishing allergy as etiological agent has been tried.Methods: A present study which was conducted over 2 years in children between 2 to 12 years who visited tertiary health care centre, Kurnool medical college and general hospital. The allergic respiratory cases based on typical history and clinical features were included in the study and investigated for nasal and blood eosinophilia. Children with TB, recurrent and chronic pneumonia, malnutrition, malignancy, collagen vascular disorders and those who are on steroid therapy were excluded from the study. The clinical profile of allergic rhinitis with or without asthma and nasal and blood eosinophils are studied.Results: Out of 120 patients, there was male predominance and incidence was increasing as age increases. Dust is the most common risk factor for allergic rhinitis followed by weather changes, whereas in allergic rhinitis with bronchial asthma, weather change is common risk factor followed by dust and family history.Conclusions: In children with allergic rhinitis with or without bronchial asthma, there is positive relation between nasal and peripheral smear eosinophil count.

A Case of False-negative Malaria Rapid Diagnostic Test Induced by Treatment with Doxycycline

Rapid diagnostic tests (RDTs) for malaria using antibodies against pan-Plasmodium antigen lactate dehydrogenase (pLDH) are commonly used for malaria diagnosis. The level of malaria parasitemia determined by peripheral blood smears (PBS) correlates with the pLDH concentration in most cases. We report a case of malaria recurrence associated with false-negative RDT results. A 22-year-old male patient was admitted to the Armed Forces Capital Hospital with fever and chills, and was diagnosed with malaria infection. Four days after antimalarial treatment, these symptoms recurred. After admitting to our hospital, doxycycline was administered for 4 days. Even after administration of doxycycline, the malaria parasites in blood smears remained positive, but RDT showed negative results. Therefore, for patients receiving doxycycline, serial blood smear testing should be performed to exclude false-negative malaria RDT results.

Identification Of Megaloblastic Anemia Cells Through The Use Of Image Processing Techniques

Objective:Ouraimistoshowthepossibility ofusingdifferentimageprocessingtechniquesfor bloodsmearanaly-sis.Alsoouraimistodeterminethesequenceofimageprocessing techniquesto identifymegaloblastic anemiacells. Methods:Weconsiderbloodsmearimage.Weuseavariety ofimageprocessingtechniquesto identify meg-aloblasticanemiacells.Amongthesemethods,wedistinguishthemodificationofthe color spaceand the useof wavelets. Results:Wedevelopedasequenceofimageprocessing techniquesforbloodsmearimageanalysis andmegaloblasticanemiacellsidentification.Asacharacteristicfeature formegaloblasticanemia cellsidentification,we considerneutrophilimagestructure.We alsouse the morphologicalmethods of imageanalysisin order to re-veal thenuclear lobes inneutrophilstructure. Conclusion:Wecanidentify themegaloblasticanemiacells.Todothis,weusethefollowing sequenceofbloodsmearimageprocessing:color imagemodification,changeof theim-age contrast, useof wavelets and morphologicalanalysisof thecellstructure.

Diagnostic Value of Peripheral Blood Smear Spherical Erythrocyte Count in ABO-Hemolytic Disease of the Newborn / 现代检验医学杂志

Objective To evaluate the clinical value of neonatal peripheral blood smear spherical erythrocyte count in the diagnosis of ABO-HDN.Methods 165 cases clinically diagnosed with ABO-HDN in Zhongshan Boai Hospital from 2009 to 2015 were listed as the experimental group by retrospective analysis,68 cases of non-ABO-HDN were listed as control group.Besides,relevant clinical data and experimental examination were investigated,and the results of their hemolysis test were analysed.Results Peripheral blood smear spherical erythrocyte count were positive in 110 cases of 165 patients with ABO-HDN,the positive rate of spherical erythrocytes was 66.7 ％ (x2 =58.069,P＜ 0.05).The spherical erythrocyte positive rates were 68.8 ％,60.5 ％ and 66.7 ％ in patients aged ≤2d,3 ～4d,≥5d respectively.The diagnostic sensitivity of spherical erythrocytes to ABO-HDN was 66.7 ％,the specificity was 88.2 ％,the positive predictive value was 93.2 ％,and negative predictive value was 52.2 ％.When spherical erythrocyte count positive point was set as ≥5 ％ spherical erythrocytes,the diagnostic sensitivity of spherical erythrocytes to ABO-HDN was 66.7％ and the specificity was 88.2％.If the positive point was set as ≥10％ spherical erythrocytes,the sensitivity of ABO-HDN decreases to 9.3％,and the specificity reaches 98.5 ％.In ABO-HDN group,the levels of nucleated red blood cell,RDW and Ret were higher,along with the lower level of hemoglobin compared with non-ABO-HDN group (all P＜0.05).Conclusion The peripheral blood smear spherical erythrocyte count had a high sensitivity and specificity for the diagnosis of ABOHDN.Combined with jaundice,anemia and RDW,peripheral blood smear spherical erythrocyte count can provide guidance for the early diagnosis,prevention and treatment of ABO-HDN.

An Automated Draft Report Generator for Peripheral Blood Smear Examinations Based on Complete Blood Count Parameters

BACKGROUND: Complete blood count (CBC) results play an important role in peripheral blood smear (PBS) examinations. Many descriptions in PBS reports may simply be translated from CBC parameters. We developed a computer program that automatically generates a PBS draft report based on CBC parameters and age- and sex-matched reference ranges. METHODS: The Java programming language was used to develop a computer program that supports a graphical user interface. Four hematology analyzers from three different laboratories were tested: Sysmex XE-5000 (Sysmex, Kobe, Japan), Sysmex XN-9000 (Sysmex), DxH800 (Beckman Coulter, Brea, CA, USA), and ADVIA 2120i (Siemens Healthcare Diagnostics, Eschborn, Germany). Input data files containing 862 CBC results were generated from hematology analyzers, middlewares, or laboratory information systems. The draft reports were compared with the content of input data files. RESULTS: We developed a computer program that reads CBC results from a data file and automatically writes a draft PBS report. Age- and sex-matched reference ranges can be automatically applied. After examining PBS, users can modify the draft report based on microscopic findings. Recommendations such as suggestions for further evaluations are also provided based on morphological findings, and they can be modified by users. The program was compatible with all four hematology analyzers tested. CONCLUSIONS: Our program is expected to reduce the time required to manually incorporate CBC results into PBS reports. Systematic inclusion of CBC results could help improve the reliability and sensitivity of PBS examinations.

Analysis of blood smear examination results of fever patients in Jiangsu Province from 2010 to 2016 / 中国血吸虫病防治杂志

To analyze the working conditions and evaluate the effectiveness of blood smear examinations in fever patients after the start of national malaria elimination program (NMEP), and explore the suitable strategy for malaria diagnosis and surveillance in NMEP, so as to provide the evidence for the development and adaptation of malaria elimination strategies and measures in Jiangsu Province.The data of malaria epidemic situation reported by network, fever patients’ blood test tables, and epidemiological surveys of malaria cases were collected and statistically analyzed by SPSS 16.0 in Jiangsu Province from 2010 to 2016.A total of 2 367 cases of malaria cases were reported from 2010 to 2016. Among the 3 691 188 person-times of fever patients tested, there were 2 252 positives (0.06%). The number of blood tests of fever patients decreased from 742 900 in 2010 to 277 000 in 2016. At the same time, the positive rate increased from 0.04% in 2010 to 0.16% in 2016. The positive rate of blood tests of fever patients in 2016 was significantly higher than that in 2010 (χ2 = 161.61, P < 0.01). From 2010 to 2016 in Jiangsu province, the centers for disease control and prevention of cities and counties, that completed the blood review within 3 days, deleted 273 negative cases. In 2010, the centers for disease control and prevention of cities and counties deleted 61 negative cases, but in 2016, the centers deleted only 14 negative cases, and the negative rate of blood review in 2010 was significantly higher than that in 2016 (χ2 = 22.99, P < 0.01).A large number of blood smear examinations have been tested in fever patients in Jiangsu Province. It not only conforms to the strong monitoring system requirements issued by World Health Organization (WHO) in malaria elimination, but also provides the evidence for no local malaria case in Jiangsu since 2012.

Haematologist-reviewed peripheral blood smear in paediatric practice

Manual examination of the peripheral blood smear (PBS) is currently performed on a fraction of samples sent for automated complete cell count. 39 children (age range 0-16.2 years) referred to a private paediatric practice during a 16-month period were retrospectively reviewed. Clinical scenarios, haematological features, laboratory-initiated PBS review, haematologist's PBS review and final diagnosis were described. Clinical indications included isolated thrombocytopenia (n = 10), unexplained bruises (n = 5), acute febrile illnesses (n = 11), anaemia (n = 8) and others (n = 5). The laboratory reviewed the PBS in 30 cases according to preset criteria and made no conclusive remarks. All slides were reviewed by a haematologist and a diagnosis was made in 27 (69%) cases, including 7 (78%) of the nine slides the laboratory did not review. The practice of laboratory-initiated PBS review requires re-evaluation. Haematologist-reviewed PBS is an important diagnostic tool for children with anaemia, bleeding disorders and acute febrile illnesses.

Evaluation of criteria of manual blood smear review following automated complete blood counts in a large university hospital

Abstract Background: There is great interest in reducing the number of automated complete blood counts requiring manual blood smear reviews without sacrificing the quality of patient care. This study was aimed at evaluating and establishing appropriate screening criteria for manual blood smear reviews to improve the performance in a hematology laboratory. Method: A total of 1977 consecutive samples from the daily workload were used to evaluate four sets of screening criteria for manual blood smear reviews to identify samples with positive smear findings. Three sets of screening criteria were arbitrarily proposed in this study: Group 1 (narrow ranges), Group 2 (intermediate ranges), and Group 3 (wide limits) and one set (Group 4) was adapted from the International Society for Laboratory Hematology. All samples were run on Sysmex hematology analyzers and were investigated using manual blood smear reviews. Diagnostic accuracy and agreement were performed for each set of screening criteria, including an investigation of microscopic review rate and efficiency. Results: The microscopic review rates for Groups 1, 2, 3 and 4 were 73.85%, 54.52%, 46.33% and 46.38%, respectively; the false-negative rates were 0.50%, 1.97%, 2.73% and 3.95%, respectively. The efficiency and negative predictive values of Group 3 were 73.04% and 4.91%, respectively. Conclusions: Group 3 had the best relationship between safety (false-negative rate: ≤3%) and efficiency to estimate the limits of automation in performing complete blood counts. This study strengthens the importance of establishing screening criteria for manual blood smear reviews, which account for the different contexts in which hematological determinations are performed. Each laboratory should optimize the screening criteria for manual blood smear reviews in order to maximize their efficiency and safety.

Valor diagnóstico de la morfología eritrocitaria en las anemias / Diagnostic value of red cell morphology in anemias / Valor diagnóstico da morfologia eritrocitária nas anemias

A pesar de la disponibilidad de modernos equipos automatizados, el estudio de la morfología eritrocitaria en extendidos de sangre periférica continúa desempeñando un rol fundamental en el diagnóstico de las anemias. En 2005, el Grupo Internacional de Consenso para la Revisión en Hematología publicó un documento con los criterios homogéneos de acción recomendados para la selección de los frotis sanguíneos que deben ser analizados mediante microscopía. Recientemente, el Comité Internacional de Estandarización en Hematología (ICSH) elaboró una serie de recomendaciones para unificar la nomenclatura y graduar los hallazgos morfológicos anormales en el estudio de la sangre periférica. El objetivo de este trabajo fue presentar a los lectores una revisión del tema y las últimas recomendaciones de los grupos de expertos a nivel nacional e internacional para el estudio de las anemias mediante la evaluación de la morfología eritrocitaria en el frotis de sangre periférica.

Despite the availability of modern automated equipment, the study of red cell morphology in peripheral blood smears continues to play a key role in the diagnosis of anemias. In 2005, the International Consensus Group for Hematology Review published a document with uniform criteria recommended action for the selection of blood smears to be analyzed by microscopy. Recently, the International Committee for Standardization in Hematology (ICSH) produced a series of recommendations to unify the nomenclature and graduate abnormal morphological findings in the study of peripheral blood. The aim of our work was to present readers with a review of the topic and the latest recommendations of the expert groups at national and international levels for the study of anemias by evaluating red cell morphology in the peripheral blood smear.

Apesar da disponibilidade de equipamentos automatizados modernos, o estudo da morfologia eritrocitária em esfregaços de sangue periférico continua a desempenhar um papel fundamental no diagnóstico das anemias. Em 2005, o Grupo Internacional de Consenso em Revisões Hematológicas publicou um documento com os critérios uniformes de ação recomendados para a seleção dos esfregaços sanguíneos que devem ser analisados através do microscópio. Recentemente, a Comissão Internacional de Padronização em Hematologia (ICSH) produziu uma série de recomendações para unificar a nomenclatura e graduar os achados morfológicos anormais no estudo do sangue periférico. O objetivo deste trabalho foi apresentar aos leitores uma revisão do tema e as últimas recomendações dos grupos de especialistas em nível nacional e internacional para o estudo de anemias através da avaliação da morfologia eritrocitária no esfregaço de sangue periférico.