FREQUENCY AND MORPHOLOGICAL CLASSIFICATION OF ANEMIA BASED ON CBC AND PERIPHERAL SMEAR

Abstract

Background: Anemia is one of the most prevalent hematological disorders worldwide, affecting approximately 1.62 billion people globally, with a disproportionately higher burden in low- and middle-income countries such as Pakistan. Despite its well-recognized national prevalence, region-specific data on the frequency and morphological classification of anemia in Dera Ismail Khan (a district characterized by limited healthcare access, poor nutritional status, and high rates of infectious disease) remain largely absent from the published literature. Objectives: This study was conducted to determine the frequency and morphological classification of anemia using Complete Blood Count (CBC) parameters and peripheral blood smear examination in the population of Dera Ismail Khan, and to identify the predominant morphological type of anemia across different age groups. Materials and Methods: A cross-sectional descriptive study was conducted at the Department of Pathology / Hematology Laboratory, DHQ Teaching Hospital MTI, Dera Ismail Khan, over a period of 4 months (March 2026 June 2026). A total of 500 confirmed anemic patients of all age groups, and both sexes were enrolled using a consecutive non-probability sampling technique. Anemia was confirmed based on WHO-defined hemoglobin cut-off values. Venous blood samples were collected in EDTA anticoagulant tubes and processed for CBC analysis using a calibrated automated hematology analyzer. Peripheral blood smears were prepared and stained with Leishman stain and examined under oil-immersion microscopy. Anemia was morphologically classified into microcytic (MCV < 80 fL), normocytic (MCV 80–100 fL), and macrocytic (MCV > 100 fL) types based on the combined interpretation of CBC indices and peripheral smear morphology. Data were analyzed using SPSS version 25.0, and results were expressed as frequencies and percentages. Results: Of the 500 confirmed anemic patients, microcytic anemia was the most prevalent morphological type, identified in 384 patients (76.8%). Normocytic anemia was the second most frequent type, diagnosed in 104 patients (20.8%). Macrocytic anemia was the least common, observed in only 12 patients (2.4%). Age-stratified analysis revealed that the 20–39 years age group had the highest burden of anemia, comprising 290 patients (58.0%) of the total study population, followed by the 40–59 years group (134 patients; 26.8%), the 0–19 years group (50 patients; 10.0%), and the 60+ years group (26 patients; 5.2%). Microcytic anemia was the dominant morphological type across all age groups, ranging from 76.2% to 82.0%. Macrocytic anemia was absent in the 0–19 years group and was most relatively prominent in the 60+ years group (3.8%). Peripheral blood smear findings corroborated CBC-based morphological classification in all cases, with microcytic hypochromic red cells, anisocytosis, and poikilocytosis predominating in the microcytic group, normochromic normocytic morphology in the normocytic group, and macro-ovalocytes with hyper segmented neutrophils in several macrocytic cases. Conclusion: Microcytic anemia (most likely driven predominantly by iron deficiency) is the overwhelmingly dominant morphological type of anemia in the population of Dera Ismail Khan, accounting for nearly 77% of all anemia cases. The heaviest disease burden falls on individuals in the 20–39 years age group, suggesting a major contribution from iron deficiency anemia in women of reproductive age. Normocytic anemia likely reflects the growing burden of chronic disease-related anemia, particularly in older age groups, while macrocytic anemia, though infrequent overall, warrants clinical attention in elderly patients where vitamin B12 deficiency is an important reversible cause. The combined use of CBC and peripheral blood smear provides superior diagnostic accuracy compared to hemoglobin measurement alone and should be adopted as the standard approach for anemia diagnosis in this setting. These findings provide the first systematic, morphologically classified baseline dataset on anemia for Dera Ismail Khan and have direct implications for clinical management, laboratory practice, and public health policy in the district.

Keywords: Anemia, Complete Blood Count, Peripheral Blood Smear, Microcytic Anemia, Normocytic Anemia, Macrocytic Anemia, Iron Deficiency, Morphological Classification, Dera Ismail Khan, Pakistan