Development of a robust blood smear preparation procedure for external quality assessment

INTRODUCTION: The external quality assessment (EQA) scheme is particularly important for laboratory performance evaluation. Peripheral blood smears are necessary to identify morphological features, and the procedure for preparing such smears must be robust to meet the ISO 15189 standard. Although blood smear preparation is a routine activity in medical laboratories, an appropriate procedure for preparing a series of blood smears with high homogeneity and durable stability for EQA purposes has not yet been published elsewhere. For this reason, a robust procedure was developed and validated in this study. METHODS: Various factors affecting blood smear preparation, such as the amount of time collected blood samples are stored before fixation, suitable reagents, and specification parameters for each step, including fixation, staining, and timing of the staining steps, were studied. Each experiment was evaluated based on homogeneity and stability characteristics. RESULTS: Whole blood mixed with EDTA anticoagulant was used to make the blood smears. Samples were fixed with pure anhydrous alcohol and stained in Coplin jars using the Wright-Giemsa method. CONCLUSION: The homogeneity and stability of two lots of smears suitable for EQA purposes was confirmed based on intact morphology of the smears for more than 8 months at room temperature.