title: Utility of Peripheral Film Findings and its Correlation with Automated Analyzer - An Audit from Tertiary Care Hospital.
abstract: OBJECTIVE
  With the advent of automated hematology analyzer, the use of traditional microscopy of blood film has become limited. The objective of our study was to determine the percentage of peripheral blood smear review in our institution in the era of automation and to identify reasons of manual review.
  
  
  METHODS
  This was a prospective audit from January 1, 2015, to January 15, 2015. Consecutive complete blood count (CBC) samples and peripheral smear requests made up the sample size. All age groups and genders were included. CBCs were performed on Sysmex XE-5000. The variables to be analyzed included inpatient and outpatient samples, frequency of peripheral film review, identifying reasons of smear review, and addition of information missed by the automated analyzer.
  
  
  RESULTS
  We analyzed 1200 consecutive CBC samples. Peripheral smear was reviewed in 500 (42%) of the cases of which, 241 were inpatient, and 259 were outpatient samples. In 384/500, the findings of hematology analyzer correlated with peripheral smear review. Flags identified included nucleated red blood cells (NRBCs) in 155 (40%), immature white blood cell (WBC) 129 (34%), and atypical lymphocytes 100 (26%). In 23% of the cases, the analyzer missed important findings. The sensitivity of abnormal histogram in our study was 91.3%, while the sensitivity of abnormal parameters was 100%.
  
  
  CONCLUSIONS
  Peripheral smear review was performed in 42% of the cases. The analyzer identified NRBC, immature WBC precursors, and atypical lymphocytes as the most common abnormality. The information correlated in 77% of the cases.
authors.affiliation: Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Pakistan.
authors.forename: Sidra
authors.initials: S
authors.lastname: Asad
authors.affiliation: Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Pakistan.
authors.forename: Imran
authors.initials: I
authors.lastname: Ahmed
authors.affiliation: Department of Pathology and Laboratory Medicine and Oncology, The Aga Khan University, Karachi, Pakistan.
authors.forename: Natasha
authors.initials: N
authors.lastname: Ali
keywords: Automated analyzer; complete blood count; peripheral film