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Recommendations in the literature and publications of scientific societies have proposed classification systems and levels to report blood cell changes in the complete blood count CBC.

Aiming to standardize the results released in the clinical laboratory, the standardization in hematoscopy is an important action within the quality assurance, contributing for diagnosis and appropriate follow-up of patients. In the week period, slides of CBC were selected from 53 patients from the four intensive care units ICUs at the hospital, three slides per patient.

The readings of the slides were performed by the analysts on duty and by two other quality analysts-control who used the criteria standardized by Palmerall analyses were blind and independent. For the analyzed parameters, there was leitura de hemograma to excellent agreement among the quality analysts-control, and when they were compared to the analysts on duty, there was a slight to substantial agreement.

The study evidenced the need of standardization of the criteria for hematoscopy used by analysts to obtain reproducible results that reflect quality and reliability by leitura de hemograma prescribing physician.


Therefore, it is necessary to invest in training the professionals involved in revision of blood smear slides. It consists of the quantitative and qualitative evaluation of the cellular elements of the blood 1. Due to the modern instrumentation and technological sophistication of clinical laboratories, particularly those considered of medium and high complexity, for some time ago, the blood cell count have been predominantly performed by automated equipment or automated counters 2.

The hemocytometer available in the market leitura de hemograma variation on the methodologies used for cell counting and leitura de hemograma, as well as differing in the runtime of the exam, the number of parameters analyzed and the methods of determination of hematimetric indices directly or calculated determination 3.

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Several automated counting models issue flags when they detect changes in cell morphology, erythrocyte size, and presence of erythroblasts, immature granulocytes IGblasts and atypical lymphocytes.

The criteria for the blood smear slides review and differential counting performed by analyst depends on the ability of the equipment used to recognize abnormalities and to issue flags, as well as the characteristics of the population assisted, such as origin, age group and current clinical condition.

In laboratories that leitura de hemograma patients coming from urgency and emergency care units or hospitalized patients, it becomes even more important to adopt specific criteria for slides reviewing, since these patients usually are those which have diseases or are in the process of diagnostic investigation.

Hematologic changes observed by microscopy are important for the diagnosis and should be notified in the laboratory examination report. Some are objects of quantification by the electronic counter itself, for example, the mean corpuscular volume MCVmean corpuscular hemoglobin MCH and range of red cell distribution or red cell distribution width RDW.

The current counters perform the counting and measurement of the erythrocytes by either impedance or optical method, incorporating the individual corpuscular volumes and generating the MCV. RDW is a by-product of the Leitura de hemograma electronic measurement used for the evaluation of erythrocytes volume heterogeneity.

MCH is calculated by the ratio of hemoglobin to the number of red blood cells RBC and represents the mean amount of hemoglobin per erythrocyte 1. Other changes, such as poikilocytosis shape change in RBCare not related to data provided by the hemocytometer or cannot be converted into numbers or percentages.

However, it is essential that such changes are notified to the prescriber 1. Hematology textbooks and propositions of some laboratories present systems and classification levels for blood cell morphological changes. There is no evidence that a classification system is better, but standardization is an important action and has an impact on quality assurance of results, and is considered good laboratory practice and recommended by the accreditation services 6.

The Standardization Committee on the Hematological Morphology Nomenclature of the International Council of Standardization in Haematology ICSH published a leitura de hemograma using consensus opinions on the topic with the purpose of organizing a set of recommendations on nomenclature and for reporting abnormalities of red blood cells, leukocytes and platelets 5.

In Brazil, the laboratory leitura de hemograma assurance programs 7 have adopted these same criteria for nomenclature of morphological changes.

However, there is still no consensus regarding the system and classification levels of some parameters obtained by automated hematology equipment, such as RDW, MCV and MCH, for example. The absence of standardization may lead to mistakes or inconsistencies in the release of results and consequently in leitura de hemograma clinical interpretation of them.

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Each laboratory should establish standardized procedures for the review of the slides and develop information and training policies to ensure the application of the established criteria 4.

In order to allow the establishment of a standardized system with classification levels for blood count elements in order to be adopted and to discuss the need for standardization of the hematocrit abnormalities expression measured in blood count reports. Data collection occurred in a week period April to June The hospital is a reference for urgency and trauma and meets the levels of attention of medium and high complexity.

It has leitura de hemograma adult intensive care units ICUsone pediatric ICU, one neonatal ICU, emergency department, surgical center, urgency and emergency care and pediatric ward, medical clinic and surgical clinic 8.

The order of ICUs participation and patient selection are shown in leitura de hemograma Figure. After the analyst on duty reading, the slides of the selected patients were stored. The readings were performed using double-blind criteria, without consulting the results of the analysts on duty and between the analysts-control.


For all slides, a differential count of at least leukocytes was performed for quantification of blasts, IG and atypical lymphocytes.