International Journal of Clinical Research

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.

Fully automated hematology analyzer; Blood smear microscopy; Routine blood test; Accuracy comparison