COMPARATIVE EVALUATION OF PERIPHERAL BLOOD SMEAR, RBC INDICES, AND RBC HISTOGRAM IN THE DIAGNOSIS OF ANAEMIA IN ADULTS AT A TERTIARY CARE CENTRE
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Keywords
Anaemia, Peripheral Blood Smear, RBC Histogram, RBC Indices, Normocytic Anaemia, Microcytic Anaemia, Automated Haematology Analyzer
Abstract
Anaemia is a major global health concern with high prevalence in low- and middle- income countries. Accurate classification of anaemia is essential for appropriate management.
Peripheral blood smear (PBS) examination provides detailed morphological information, while automated haematology analyzers offer objective RBC indices and histogram patterns. Limited studies have compared these modalities in adult anaemic populations in India.
Aim: To evaluate peripheral blood smear findings in adult anaemia and compare them with RBC indices and RBC histogram patterns for identifying concordance and diagnostic utility.
Materials and Methods: This descriptive cross-sectional study included 390 adults with haemoglobin <11 g/dL at a tertiary care centre in Udaipur. Venous blood samples were analyzed using a HORIBA six-part differential haematology analyzer. RBC indices (MCV, MCH, MCHC, RDW) and histogram patterns were recorded. Peripheral blood smears were prepared, Giemsa- stained, and examined for morphological classification. Anaemia was categorized as normocytic normochromic, microcytic hypochromic, macrocytic, dimorphic, or haemolytic. Correlation between PBS morphology, RBC indices, and histogram interpretation was evaluated using Chi- square and t-tests. A p-value <0.05 was considered significant.
Results: Females constituted 62.31% of cases. The mean age was 36.87 ± 16.74 years, with most cases occurring in the 18–28 years age group. The most common clinical symptoms were fatigue (69.23%) and shortness of breath (65.38%). Histogram interpretation showed 54.10% normocytic normochromic, 37.69% microcytic hypochromic, 6.15% macrocytic, and 2.05% dimorphic patterns, identical to PBS morphology (p = 1). Histogram curve patterns showed a significant association with PBS findings (p < 0.001), with normal curves correlating with normocytic anaemia, left- shifted curves with microcytic anaemia, and bimodal curves with dimorphic anaemia. RBC indices also demonstrated expected changes across anaemia types.
Conclusion: PBS examination, RBC indices, and histogram interpretation are complementary diagnostic tools in anaemia evaluation. The strong concordance between histogram patterns and PBS morphology underscores the reliability of automated analysis. Combining both manual and automated methods enhances diagnostic accuracy and should be routinely incorporated into haematological assessment.
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Dr Nishu Grover
Post Graduate Student, Department of Pathology, RNT Medical College, Udaipur, Rajasthan, India.
Dr Gunja Dwivedi
Associate Professor, Department of Pathology, RNT Medical College, Udaipur, Rajasthan, India.
Dr Shiwangi Chhanwal
Post Graduate Student, Department of Pathology, RNT Medical College, Udaipur, Rajasthan, India.
Dr Minal Jain
Post Graduate Student, Department of Pathology, RNT Medical College, Udaipur, Rajasthan, India.
Dr Jatin Prajapati
Senior Resident, Department of Community Medicine, World College of Medical Sciences and Research, Jhajjar, Haryana, India
