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Smitirupa Mishra: Standardizing RBC Morphology Reporting – Why ICSH Guidelines Matter?

Smitirupa Mishra/LinkedIn

Jun 1, 2026, 15:10

Smitirupa Mishra: Standardizing RBC Morphology Reporting – Why ICSH Guidelines Matter?

Smitirupa Mishra, Consultant Pathologist at Sparsh Hospitals and Lab Head at Pathkind Labs, shared a post on LinkedIn:

“Standardizing RBC Morphology Reporting: Why ICSH Guidelines Matter

Red blood cell morphology remains one of the most valuable components of peripheral smear examination.

However, it is also one of the areas where significant inter-observer variability exists.

Terms such as ‘few’, ‘occasional’, ‘mild’, or ‘moderate’ may mean different things to different observers, leading to confusion among clinicians and inconsistency across laboratories.

This is where the International Council for Standardization in Haematology (ICSH) guidelines play a crucial role.

The ICSH recommendations provide a standardized framework for reporting RBC morphological abnormalities, including:

Anisocytosis
Microcytosis and Macrocytosis
Hypochromia
Target cells
Elliptocytes
Spherocytes
Schistocytes
RBC inclusions and other poikilocytes

By defining percentage-based grading criteria, the guidelines help:

Reduce subjectivity in reporting
Improve inter-laboratory consistency
Enhance communication with clinicians
Facilitate better patient management and follow-up
Strengthen quality assurance practices in hematology laboratories

One particularly important aspect is the reporting of schistocytes, where even small percentages can have significant clinical implications and may point toward life-threatening thrombotic microangiopathies.

As laboratory professionals, adopting standardized reporting systems is not merely about compliance—it is about improving diagnostic accuracy and ensuring that every morphology report conveys clear, reproducible, and clinically meaningful information.

The next time you report an RBC morphology, ask yourself:

Are we describing what we see, or are we reporting it in a standardized manner that others can interpret consistently?

Standardization transforms morphology from an art into a reproducible science.”

Smitirupa Mishra