RBC Histogram as supplementary diagnostic tool with peripheral smear examination in evaluating anemias

  • Byna Syam Sundar Rao Ntr university of health sciences,Narayana medical college,Dept of pathology,Nellore.
  • Vissa Santhi
  • Nandam Mohan Rao
  • Bhavana Grandhi
  • Vijaya Lakshmi Murra Reddy
  • Praveena Siresala
Keywords: RBC Histogram, Anaemia, Blood indices, Red cell distribution width.


Background:  Red blood cell(RBC) histogram provide an idea about morphological changes of  red blood cells in hematological disorders. Peripheral smear examination findings are usually correlated with complete blood cell counts by automated analyzer. To known the utility and advantage of red cell histogram and correlation of microscopic examination of peripheral smear with automated histogram pattern. Methods: Blood  sample was collected from 220 anemia patients in  ethylene diamine tetra acetic acid (EDTA) tubes for peripheral smear examination and ran in Beckman coulter LH 780  automated hematology analyzer for obtaining histogram, complete blood count includes  hemoglobin, total leucocyte count, Platelet count, red blood cell indices and red cell distribution width. This  study was undertaken  for a period of one month  of  November  2016 in department of pathology,  central laboratory, narayana  medical college & hospital, Nellore. Results:  This study of histograms of  220 different types of  anemia consisted predominantly  females 154 (70%) , and  males 64(30%) . Maximum cases of anemia  were noted in 30-40 years of age range. Microcytic hypo chromic anemia was the most common (63.63%) followed by  normocytic normochromic anemia (19.4%), macrocytic  hypochromic anemia (2.2%), dimorphic anemia (12.72%) and pancytopenia (1.8%).Left shifted curve and broad base mostly seen in microcytic anemia, right shift curve seen in macrocytic  anemia  and bimodal peak mostly seen in dimorphic anemia.Conclusion: Histogram  can be used as  an important  screening  test for hematology and  can  become a new parameter  in the diagnosis of anemia though peripheral examination remains the definitive diagnostic  test for evaluation.DOI: 10.21276/APALM.1468

Author Biography

Byna Syam Sundar Rao, Ntr university of health sciences,Narayana medical college,Dept of pathology,Nellore.
Dept of pathology,Narayana medical college, Nellore


1. Bessman JD, Gilmer PR Jr, GardnerFH. Improved classification of anemias by MCV and RDW.Am J clin pathol.1983: 80(3):322-6
2. Fossat C, David M, Harle JR, Sainty D, Horschowski N, Verdot JJ, Mongin M et al. New parameters in erythrocyte counting value of histograms. Archpathol Lab Med. 1987;111(12):1150-54
3. Gulati GL, Hyun BH; The Automated CBC. A current perspective. HematoloncolClin North Am.1994;8(4):593-603
4. Bessman JD. Red bllod cell fragmentation: Improved detection and identification of causes.Am j clin pathol.1988:90(3):268-73
5. Sandhya I, Muhasin T.P. Study of RBC Histogram in various anemias. Journal of Evolution of Medical and Dental sciences 2014; 3( 74),15521-34
6. Chavda J, Goswami P, Goswami A. RBC histogram as diagnostic tool in anemias. IOSR Journal of Dental and Medical Sciences .2015;14(10), 19-22
7. Benie T. Constantino SH. The Red Cell Histogram and The Dimorphic Red Cell Population .LAB MEDICINE.2011;42(5):300-8
8. Brigden ML. A Systemic approach to macrocytosis: sorting out the causes. Postgrad Med. 1995;97(5):171-84.
9. Kaferle J, Strzoda CE. Evaluation of macrocytosis. Am Fam Physician. 2009; 79(3): 203-8.
10. Argento V, Roylance J, Skudlarska B, et al. Anemia prevalence in a home visit geriatric populations. J Am Med Dir Assoc, 2008;9(6):422-6
11. Younis M, Daugher GA, Dulanto JV, Njeim M, Kuriakose P. Unexplained macrocytosis. South Med J.2013;106(2):121-5
12. McNamee T, Hyland T, Harrington J, Cadogan S, Honari B, Perera K, et al. Haematinic deficiency and macrocytosis in middle-aged and older adults. PLoS One. 2013; 8 (11): e77743
Original Article

Most read articles by the same author(s)