interpreting-hematology-smears
Interpreting Hematology Smears
Structures peripheral blood smear review with morphologic descriptions and differential correlation.
Why This Skill Exists
The peripheral blood smear remains an indispensable diagnostic tool that no automated analyzer can fully replace. While modern hematology analyzers provide accurate cell counts, they cannot identify morphologic abnormalities that drive diagnosis: blast cells in acute leukemia, schistocytes in thrombotic microangiopathy, malaria parasites, or hypersegmented neutrophils in megaloblastic anemia. The International Council for Standardization in Haematology (ICSH) and the CLSI H20-A2 guideline establish standards for smear preparation, review criteria, and morphologic grading.
CAP accreditation (Hematology HEM checklist) requires documented criteria for automated smear review triggers, competency in morphologic identification, and quality assurance for manual differentials. CLIA mandates that peripheral blood smear review is performed or supervised by qualified personnel. The pathologist or hematopathologist sign-out on abnormal smears carries the weight of a diagnostic interpretation. Missing schistocytes in a patient with TTP-HUS or failing to identify circulating blasts can result in fatal delays.