Blood Smear Artifacts from Underfilled EDTA Tubes

How excess EDTA in small blood volumes distorts analyzer scattergrams and cell morphology: echinocytes, nuclear pyknosis, and endothelial aggregates.

Владимир Тимочко 1 min December 3, 2021

EDTA tube with critically low blood volume

WDF scattergram from a hematology analyzer with an atypical cloud

Hematology analyzer screen with complete blood count results

Blood smear: erythrocyte crenation and a nucleated cell with pyknosis

Blood smear: destroyed cell and artifactual erythrocyte changes

Blood smear: compact cell complex, likely endothelial

Blood smear: large syncytial cell aggregate

Blood smear: massive accumulation of endothelium and cellular detritus

👋 Oh, what a blood sample we got today. Insufficient volume. But we’re not used to being discouraged. We processed it. The scattergram was concerning. We took it for a leukocyte differential count. And there… there was everything. I don’t even know how to describe it. Ultimately, the blood was rejected, assuming preanalytical influence (small blood volume, cell-platelet aggregates in the smear, nuclear pyknosis). What do you think this could be? We really don’t want to miss some rarity due to our intellectual imperfection. Oh, by the way, the slides were not used for urine or gynecology. Excluded 👌 Likes on avatars for comment authors 😉