Correspondence Address:
Vikram Narang
Associate Professor, Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab
India

Full Text



We received 3 ml EDTA blood sample of a 49-year-old male from Emergency department for routine complete blood count and peripheral smear examination. The hematological parameters showed severe anemia (Hb = 5.8 gm/dl) with thrombocytopenia (68000/μl), MCV-118.2 fl and normal TLC (10200/μl). On peripheral blood smear examination, red blood cells appeared elongated with blunt ends along with red cell fragmentation, hyperchromia, and focal red cell aggregation [Figure 1]. The possibility of agglutination with red cell fragmentation was considered and further clinical details were sought which revealed him to be a case of NASH related cirrhosis now presenting to the emergency department with of malena and mild splenomegaly.{Figure 1}

After ruling out the causes of smearing artifacts (like defects in spreading techniques) and EDTA associated issues, it was found that the sample was in an outside box for few hours before the courier had transported it in appropriate temperature regulated box. Therefore, these melting RBC in smear were heat induced. The present case not only shows the peculiar red cell morphology due to heat artifact but also highlights the importance of smear examination in quality assurance of clinical hematology laboratory.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.