Background
A manual blood smear review is defined as the thorough and careful
microscopic analysis of a well-prepared and stained smear of the
peripheral blood, with the objective of seeking morphological changes
relevant to the diagnosis and monitoring of patients(1).
Laboratory-initiated examinations of blood smears for patients with
anemia are usually the result of a laboratory policy according to which
a blood smear is ordered whenever the hemoglobin concentration is
unexpectedly low. In these cases, despite the wealth of the captured
information from modern automated cell counters including red-cell
count, mean cell volume(MCV), mean cell hemoglobin(MCH), mean cell
hemoglobin concentration(MCHC) and red-cell–distribution width(RDW),
there are still morphologic abnormalities that are critical in the
differential diagnosis of anemia and can be determined only from a blood
smear. Particularly important is the detection of variations in the cell
shape and of red-cell inclusions, such as Howell– Jolly bodies,
Pappenheimer bodies and basophilic stippling or punctate basophilia. The
last could suggest lead poisoning in the setting of matched clinical
data (2).