Vol. 8, Issue 3, Part B (2025)

Background: Automated hematology analyzers generate red blood cell (RBC) histograms that provide valuable morphological information complementing traditional complete blood count (CBC) parameters in anemia diagnosis. However, their clinical utility remains underutilized in routine practice despite the potential for improved diagnostic efficiency.
Objective: To evaluate the diagnostic accuracy of RBC histogram analysis in identifying different types of anemia and assess concordance with CBC parameters in a hospital-based patient population.
Methods: A prospective cross-sectional study was conducted on 925 anemic patients aged 5-90 years from January to December 2024 at a tertiary care teaching hospital. RBC histograms, CBC parameters, and clinical histories were analyzed using automated hematology analyzer (Sysmex XN-350 series). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated for each anemia type using standard statistical methods.
Results: The study population comprised 592 pediatric patients (64.0%) and 87 adult patients (9.4%) with 246 cases of unknown age classification. Left shift histogram pattern was most prevalent (255 cases, 27.6%), followed by slight left shift (199 cases, 21.5%). RBC histogram analysis demonstrated excellent diagnostic performance with overall concordance rate of 95.2%. Sensitivity ranged from 90.9% to 98.0% across anemia types, while specificity ranged from 89.7% to 98.1%. Microcytic hypochromic anemia showed highest sensitivity (98.0%) and accuracy (97.0%).
Conclusion: RBC histogram analysis demonstrates excellent diagnostic performance in anemia classification with high sensitivity and specificity across all anemia types. The integration of histogram patterns with CBC parameters provides reliable diagnostic information that can enhance clinical decision-making, particularly valuable in resource-limited settings where rapid and standardized anemia diagnosis is essential.