Diagnostic Value of Routine Peripheral Blood Smear Review in a High-Volume Outpatient Hematology Laboratory: A Quality-of-Care Assessment

Automated complete blood count (CBC) analyzers provide rapid and reliable hematologic measurements; however, clinically significant morphologic abnormalities may not be fully characterized by automated testing alone. Peripheral blood smear review remains an important component of laboratory quality assurance and may contribute to improved recognition of hematologic disorders. This study evaluated the quality-of-care impact of routine smear review in a high-volume outpatient laboratory.

A laboratory-based quality assessment was performed in an outpatient polyclinic processing approximately 1,500 CBC tests monthly. All CBC results underwent professional review, including verification of differential leukocyte counts, platelet assessment, and peripheral blood smear examination when indicated. Morphologic evaluation focused on abnormalities associated with iron deficiency anemia, macrocytic anemia, thalassemia syndromes, and other clinically relevant hematologic abnormalities.

Routine peripheral smear review identified morphologic abnormalities requiring clinical attention in approximately 50 cases per month among 1,500 CBC evaluations. Frequently observed findings included features suggestive of iron deficiency anemia, macrocytic anemia, and thalassemia syndromes. Morphologic assessment provided additional diagnostic information beyond automated hematology parameters and supported verification of analyzer-generated results.

Routine peripheral blood smear review remains a valuable quality-of-care practice in hematology laboratories. In a high-volume outpatient setting, microscopic morphologic assessment complements automated CBC testing and contributes to recognition of clinically significant hematologic abnormalities. Incorporation of structured smear review into laboratory workflows may improve diagnostic quality and support optimal patient management.