Comparison of the accuracy differences between fully automated blood analyzers and blood smear microscopy in routine blood tests
比较全自动血液分析仪与血涂片镜检在血常规检验中的准确性差异

摘要

目的 系统比较全自动血液分析仪与血涂片镜检在血常规关键项目检测中的结果差异。方法 采用回顾性研究方法，选取2024年8月至2025年8月本院1250例同时进行仪器检测与人工镜检的静脉血标本作为研究对象。以双盲法镜检结果为参考标准，对比分析全自动血液分析仪在白细胞分类、异常细胞识别及血小板计数等方面结果的符合率与差异。结果 在白细胞五分类上，仪器对正常标本结果可靠，但与镜检的总体符合率为92.4%。镜检发现187例（14.96%）存在形态异常或干扰，仪器对此类标本的分类准确性下降。在血小板计数方面，对于无聚集标本，两种方法一致性良好（P>0.05）；但在22例镜检确认血小板聚集的标本中，仪器计数低于镜检估算值（P<0.001）。仪器对幼稚细胞和异型淋巴细胞的报警灵敏度较高（分别为90.0%和91.2%），但存在一定假阳性。结论 全自动血液分析仪适用于大批量标本的快速、标准化筛查，但其在细胞形态识别及抗干扰能力方面存在局限。血涂片镜检是识别细胞形态异常和验证仪器可疑结果的必要补充。二者联合应用是确保血常规检验结果全面、准确的最佳模式。

Abstract

Objective To systematically compare the differences in the results of key routine blood test parameters between fully automated hematology analyzers and blood smear microscopy.
Methods A retrospective study was conducted on 1,250 venous blood specimens from our hospital between August 2024 and August 2025, all of which underwent both automated analysis and manual microscopy. Using blinded microscopy results as the reference standard, the concordance rates and discrepancies between the fully automated hematology analyzer and microscopy were compared and analyzed regarding white blood cell (WBC) differential counts, abnormal cell identification, and platelet (PLT) counts.
Results For the five-part WBC differential, the analyzer provided reliable results for normal specimens, with an overall concordance rate of 92.4% compared to microscopy. Microscopy identified morphological abnormalities or interferences in 187 cases (14.96%), for which the analyzer’s classification accuracy decreased. Regarding platelet counts, both methods showed good agreement for specimens without aggregation (P>0.05). However, in 22 specimens where platelet aggregation was confirmed by microscopy, the analyzer counts were significantly lower than the microscopy estimates (P<0.001). The analyzer demonstrated high alert sensitivity for blast cells and atypical lymphocytes (90.0% and 91.2%, respectively), but with a certain rate of false positives.
Conclusion   Fully automated hematology analyzers are suitable for rapid, standardized screening of large batches of specimens but have limitations in cell morphology recognition and anti-interference capability. Blood smear microscopy remains a necessary supplement for identifying cell morphological abnormalities and verifying suspicious instrument results. The combined application of both methods constitutes the optimal model for ensuring comprehensive and accurate routine blood test results.