What this test measures
Blood spread thinly on a slide, fixed, stained, and examined microscopically. Used to assess RBC morphology, WBC differential and morphology, platelet count and morphology, and presence of malaria / microfilariae / other parasites.
Why it matters
Essential for completing the haematology assessment — anaemia workup, suspected leukaemia, suspected haemolytic anaemia, fever of unknown origin, malaria diagnosis in endemic areas. CBC numbers + smear together are the foundation of haematology.
How to prepare
No fasting required. EDTA whole blood, processed within 4-6 hours. Disclose recent transfusion, antibiotics / antimalarials, suspected malaria / dengue / parasites, and current symptoms.
Markers & reference ranges
Reference ranges below are typical adult values. Your lab's reported range may differ slightly based on the assay platform and patient demographics — always read your report against the range printed on it.
| Marker | Normal range | If low | If high |
|---|---|---|---|
| RBC Morphology (descriptive)[1] | Normocytic normochromic, no abnormal forms | Hypochromic / microcytic — iron deficiency / thalassemia. Macrocytic — B12 / folate / liver / alcohol. | Spherocytes, schistocytes, sickle cells, target cells, basophilic stippling, bite cells, Howell-Jolly bodies — each points to specific diagnoses. |
| WBC Differential + Morphology (descriptive + %) | Neutro 40-70%, Lymph 20-40%, Mono 2-10%, Eos 1-6%, Baso 0-1% | Neutropenia / lymphopenia / pancytopenia — investigate marrow / infection / drug cause. | Neutrophilia with toxic granulation = bacterial; atypical lymphs = viral; blasts = acute leukaemia (urgent); eosinophilia = parasites / allergy. |
| Platelets (estimate) | 8-15 / oil field | True thrombocytopenia or platelet clumping artefact (repeat in citrate to distinguish). | Reactive vs essential thrombocytosis. |
| Parasites (present / absent) | Absent | Single negative smear does not rule out malaria — repeat every 8-12h × 2-3 days. | Malaria (speciate + parasitaemia), microfilariae, trypanosomes. |
Smear findings → diagnoses
| Finding | Suggests |
|---|---|
| Hypochromia + pencil cells | Iron deficiency |
| Target cells + basophilic stippling | Thalassemia trait |
| Hypersegmented neutrophils + macrocytes | B12 / folate deficiency |
| Schistocytes + thrombocytopenia | MAHA — emergency |
| Blasts | Acute leukaemia — urgent |
| Atypical lymphocytes | EBV / CMV / dengue |
| Plasmodium | Malaria — speciate + parasitaemia |
Frequently asked questions
How is this different from PBS?
Same test — different name. Some labs use "Peripheral Smear Examination" and others "Peripheral Blood Smear / PBS".
Why do I need it if CBC is normal?
CBC misses cell morphology, parasites, blasts, and atypical lymphocytes. Smear is essential in unexplained anaemia, suspected leukaemia, fever workup.
Can a single negative smear rule out malaria?
No — repeat every 8-12 hours for 2-3 days if suspicion persists.
How long to get results?
Most labs report within 24 hours.
Related Histopathology / Cytology tests
Tests commonly ordered alongside Peripheral smear examination, or that help interpret an unexpected result.
Sources & references
- BSH — Peripheral Blood Film Examination · accessed 2026-05-30T00:00:00.000Z
- NIH MedlinePlus — Blood Smear · accessed 2026-05-30T00:00:00.000Z
- ASH — Blood Smear Examination · accessed 2026-05-30T00:00:00.000Z
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