Question: What is the use and interpretation of the peripheral blood smear?

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Unique Identifier 86135718

Authors: Clodfelter RL Jr.

Institution: Department of Radiology, Hopital Calmette, Lille, France.

Title: The peripheral smear. [Review] [61 refs]

Source: Emergency Medicine Clinics of North America. 4(1):59-74, 1986 Feb.

Abstract: The CBC "with differential" presently includes a blood smear that is examined by the medical technologist and is available for the physician. With increased familiarity of the technique for blood smear preparation and interpretation, the emergency physician must include peripheral blood smear review as part of the emergency department evaluation of bleeding disorders, anemia, infectious disorders, and suspected leukemia. Knowing the variations in morphology of blood cells in specific disease states should help the physician to intelligently order and meaningfully interpret the peripheral blood smear. It is a test commonly available but awaits full use by physicians in emergency medicine. [References: 61]

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Unique Identifier 76217910

Authors: Wallerstein RO.

Institution: Dept. of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA.

Title: Role of the laboratory in the diagnosis of anemia.

Source: JAMA. 236(5):490-3, 1976 Aug 2.

Abstract: PURPOSE: To determine the sensitivity and specificity of helical computed tomography (CT) for the diagnosis of acute pulmonary embolism. MATERIALS AND METHODS: This prospective study included 47 patients who underwent pulmonary arteriography for evaluation for possible acute pulmonary embolism. Tailored helical CT and pulmonary arteriography were performed within 24 hours of each other. Each CT scan was interpreted by two chest radiologists, blinded to arteriographic results, at two institutions. CT scan interpretations were compared with findings on bilateral selective pulmonary arteriograms interpreted by two vascular radiologists at one institution. RESULTS: Fifteen (32%) of 47 patients had angiographically proved pulmonary embolism. For the readers at the first institution, helical CT had 60% sensitivity, 81% specificity, 60% positive predictive value, 81% negative predictive value, and 75% overall accuracy. For the readers at the second institution, helical CT had 53% sensitivity, 97% specificity, 89% positive predictive value, 82% negative predictive value, and 83% accuracy. CONCLUSION: Detection of pulmonary embolism with helical CT may be less accurate than previously reported. Given its high specificity but relatively low sensitivity, helical CT may not have the ideal attributes of a first-line imaging study for the diagnosis of pulmonary embolism.

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