Objectivity and Practice of Peripheral Blood Smear Examination for Childhood Anemia Diagnosis in Benghazi Children Hospital /Libya

Abstract

Introduction: Anemia is a common disease in children. Peripheral Blood Smear (PBS) require effort and human resource. In this study, we will evaluate objectivity of PBS ordering practice in Benghazi Children Hospital/Libya. Method: A retrospective study of PBS reports of 318 child in 2015 was conducted. Data collected include cause of PBS request, along with other relevant demographic, clinical and laboratory details. Kappa statistic was used for analyzing degree of agreement of results between PBS and Complete Blood Count (CBC) in anemia diagnosis. Results: Our study showed that Hematologists and 88.7% by general pediatricians requested only 6.9% of PBS. Anemia was main cause of request in 36.2%. Only 33.7 % of OPD cases referred with suspect of anemia were revealed to be anemic upon PBS examination and 45.4 % referred with no suspect of anemia were revealed to be anemic upon examination in total study population, but not in Neonate. In 65.1%, there was an agreement between diagnosis of anemia by CBC and PBS. There was accordance of 76.6% between exclusion of anemia by CBC and PBS. Hypochromic microcytic anemia was diagnosed in 93 cases (29.2%), macrocytic anemia was diagnosed in 5%, and 65.7% were not anemic. Conclusions: PBS examination is none objectively ordered and over utilized by Pediatricians in outpatient settings and for routine practice with less yield. Establishing laboratory guidelines for improving utility of PBS, careful and complete justified requests, discussion with laboratory staff, and continuous auditing practice are noticeable needs in the Benghazi Children Hospital.