Overview
Standardized smear terminology for erythrocyte morphology reporting.
Classification
| Term | Smear finding | Index correlate | Differential associations (not exclusive) |
|---|---|---|---|
| Microcytosis | Smaller than normal RBC | Low MCV | Iron deficiency, thalassemia, ACD, others |
| Macrocytosis | Larger than normal RBC | High MCV | B₁₂/folate deficiency, liver disease, MDS, reticulocytosis, others |
| Anisocytosis | Mixed sizes | Elevated RDW | Dual deficiency, transfusion, mixed populations |
| Hypochromia | Increased pallor | Low MCH/MCHC | Iron-deficient pattern, thalassemia, others |
| Spherocyte | No central pallor, round | May raise MCHC | Hereditary spherocytosis, AIHA, others |
| Schistocyte | Fragment | , | Microangiopathic hemolysis, mechanical trauma, others |
| Target cell | Central hemoglobin dot | Often microcytic | Thalassemia, liver disease, Hb C, others |
| Howell-Jolly body | Round nuclear remnant | , | Hyposplenia, megaloblastic anemia, others |
| Basophilic stippling | Blue punctate inclusions | , | Lead, thalassemia, sideroblastic, others |
Morphologic Features
Use Wright-Giemsa at monolayer. Compare to internal smear controls when available.
Laboratory Characteristics
- Descriptive smear comments per institutional style guide
Reference Intervals
Morphology is qualitative, indices use report-specific intervals only.
Clinical and Laboratory Significance
Patterns suggest mechanism branches, confirmatory testing clinician-directed.
Differential Considerations
Never assign one morphology finding to one disease exclusively.
Comparison Tables
Classification Frameworks
Laboratory Notes
- Interpret results against the performing laboratory reference intervals and current SOP.
References
Authoritative textbooks, guidelines, and reviews supporting this reference entry. Verify reference intervals, critical limits, and reflex criteria against institutional protocols and current guideline editions.
Textbooks
- McPherson RA, Pincus MR. Henry's Clinical Diagnosis and Management by Laboratory Methods. 24th ed. Elsevier; 2021.
- Rodak BF, Carr JH. Rodak's Hematology: Clinical Principles and Applications. 6th ed. Elsevier; 2020.
- McKenzie SB, Williams JL. Clinical Laboratory Hematology. 4th ed. Pearson; 2022.
- Bain BJ. Blood Cells: A Practical Guide. 5th ed. Wiley-Blackwell; 2015.
CLSI and Professional Guidelines
- Clinical and Laboratory Standards Institute. Reference and Selected Performance Standards for the Automated Complete Blood Cell Count (CBC). CLSI document H26-A2. CLSI; 2010.
- Clinical and Laboratory Standards Institute. Defining, Establishing, and Verifying Reference Intervals in the Clinical Laboratory; Approved Standard. CLSI document EP28-A3c. CLSI; 2010.
- Clinical and Laboratory Standards Institute. Management of Critical- and Significant-Risk Results. CLSI guideline GP47-Ed1. CLSI; 2015.
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