Examination of smear bya physician who is aware of pt’s clinical condition is very useful. Even highly skilled lab technitians could overlook subtle changes. Indices are machine generated by averaging analysis.
Mention on PLT on oil emersion view 7-20. Check for clumping when low PLT (EDTA induced clumping).
Ferritin sen=90% spec=80%
Insufficient production of protoporphyrin to utilize the iron or unavailability of ferrous iron for insertion into protoporphyrin
Three part (B12; B12 + IF; Antibiotic)
Ruloux in MM Auer rods in AML
Systematic Approach in Anemia Evaluation and Review of Peripheral Smears Jun W. Kim, MD Family Medicine Residency Dewitt Army Community Hospital
Anemia Differential Dx by Flow Chart MCV/smear Micro Normo Macro Iron panel Retic Low Retic High High Low Iron/B12/Folate *Occult Blood Loss Yes No Coombs (+) Coombs (-) Go to *Occult Blood Loss B12/Folate B12 Low Folate/Low Normal MMA/Homocysteine MMA high – B12 Low Homocysteine high – Folate Low Normal – Go to ** **Normal Bone Marrow Bx Anemia of Chronic Dis.
First use size ( MCV ) to sort the Differential Dx MCV Micro Normo Macro