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).