Opening laboratory problem

A promptly prepared ethylenediaminetetraacetic acid (EDTA) peripheral smear is reviewed after a red blood cell (RBC) fragments flag. In the well-spread monolayer, helmet forms, irregular triangular fragments, and keratocytes are present. The complete blood count (CBC) shows hemoglobin 8.6 g/dL and platelets 41 × 10^9/L. First determine whether these are distributed, supported fragments rather than preparation artifact.

A smear describes visible cell features. It cannot by itself diagnose thrombotic microangiopathy, thrombotic thrombocytopenic purpura, or an inherited membrane disorder. A specific shape term is more useful than poikilocytosis alone when the form is recognizable. The result must be interpreted with specimen quality, method, other findings, and the laboratory's written review criteria.

Start with what can be seen before attaching an interpretation. Describe border, central pallor, internal detail, distribution, and whether the cell remains identifiable in adjacent fields. The routine method here is a wedge smear from EDTA whole blood, air dried, panoptically Romanowsky stained, and examined by optical microscopy in the optimal monolayer. Document the positive morphology features and specimen context before selecting an escalation path.