Utility of red blood cell histograms in various types of anemias in pediatric age group (1-18 years)

Background: Over the past few years, an automated haematology analyzer's complete blood count and a microscopic examination of a peripheral smear have complimented each other to produce a thorough report on patients' blood samples. When a simultaneous peripheral smear is recorded, it is frequently seen that histogram patterns exhibit a variety of properties. Additionally, it is evident that manual reporting of peripheral smears has a number of drawbacks, such as being subjective, time-consuming, and statistically erroneous. Microscopical peripheral smear examination does, nevertheless, also have its benefits. Aims and Objectives: 1. Utility of red cell histograms in various types of anaemia in pediatric age group (1-18years). 2. To correlate peripheral smear findings with RBC histogram patterns. Materials and Methods: The present study was undertaken inJNMC and KLE’S DR. PRABHAKAR KORE HOSPITAL and MRC. Hb levels were determined in EDTA sample by the 5 part differential autoanalyzer Sysmex XN 350. Peripheral blood smear of patients having lower limit of the normal range for the particular age and sex were made by push or wedge technique and Leishman staining is done (Procedure-Annexure). Then the slide is studied under microscope and provisional impression is made without referring to the histogram. The RBC histogram generated by the impedance principle and the RBC indices - MCV, MCHC, RDW-CV/RDW-SD were analysed. The impression derived by periprheral smear examination were then correlated with histogram patterns and RBC indices. Results: In the present study normocytic normochromic anemia was the most common anemia followed by microcytic hypochromic anemia both according to RBC indices and histogram analysis and on peripheral smear. The histogram and indices analysis correlated with peripheral smear findings in majority of microcytic hypochromic anemia, normocytic normochromic anemia and macrocytic anemia. Histogram pattern showed within normal limits in 46.43% of cases, 39.28%cases of left shift, right shift in 9.28% cases and bimodal in 5% of cases. Conclusion: Peripheral smear examination is a sensitive and gold standard method in diagnosing red blood cell disorders. Red blood cell histogram patterns and the red cell indices obtained from the hematology automated analysers act as an adjunct to the visual examination of peripheral smears.