Interpretation of RBC Histograms and their Correlation with Peripheral Smear Findings in Patients of Anemia
Keywords:Automated haematological analysers, Histogram, Anemia, Peripheral Smear
Introduction: Automated haematological analysers provide blood cell histograms by plotting the sizes of different blood cells on X-axis and their relative number on Y-axis. Histogram interpretation needs careful analysis of Red Blood Cell (RBC), White Blood Cell (WBC) and platelet distribution curves. Histogram analysis is often a neglected and underrated part of the automated haemogram which if interpreted well, has significant potential to provide diagnostically relevant information even before higher level investigations are ordered and may be a time saving tool(1). The study was aimed to correlate between the Peripheral Smear findings in patients of anemia that presented in our tertiary care hospital and the RBC histogram chart plotted by the automated analyser and how far the machine dependent histogram are near to the gold standard of investigation that is microscopy.
Material and method: Total of 500 blood samples of patients of adult age group admitted in Civil Hospital, Ahmedabad were studied from August 2019 to October 2019. Patients with haemoglobin less than 12.5gm/dl were included. The blood samples were run in Horiba Pentra XLRTM 80 , which is a 5 part differential counter. The histogram is obtained on the display of the cell counter. Peripheral smears were prepared from same samples of patients received in EDTA vacutte and stained by Geimsa stain. Then microscopy of stained Peripheral smears were done. The peripheral smear findings were then correlated with the histogram charts from cell counter with due knowledge of relevant clinical history.
Result: In our study of 500 patients, the histogram suggested 52.2% of cases as microcytic hypochromic anemia, followed by normocytic normochromic anemia 19.6%. The histogram suggested 12.6% of patients and 2.2 % of patients suffering from macrocytic anemia and hemolytic anemia respectively. In 13.4 % of cases histogram showed dimorphic picture. On confirming with Peripheral Smear finding we found that 53.4% of cases showed picture of microcytic hypochromic anemia, followed by normocytic normochromic anemia at 18.8%. The Peripheral Smear finding suggested 11.6% of patients and 3.6 % of patients suffering from macrocytic anemia and hemolytic anemia respectively. In 12.6 % of cases Peripheral smear showed dimorphic picture.
Conclusion: The peripheral blood smear examination along with Histogram analysis can prove a very promising and complementary tool in diagnosis of anemias. Histogram can provide subtle information about the RBC pathology and many a times can act as time saving method.