Review the smear in a fixed order — size, shape, chromia, inclusions — so that each step constrains the interpretation of the next and no finding is missed.
Why the order is not arbitrary
Size first confirms or refutes the MCV and reveals mixed populations that an average hides. Shape second separates a general impression of anisocytosis and poikilocytosis from the specific named shapes. Chromia third is judged against the cell diameter, not against an absolute colour. Inclusions last are searched for deliberately, because they are easy to overlook when attention is already occupied by size and shape.
What is assessed at each step
- Size: microcytes, macrocytes, and whether the population is uniform or mixed
- Shape: anisocytosis, poikilocytosis, then specific forms such as target cells, schistocytes, spherocytes, bite cells, pencil cells
- Chromia: central pallor relative to cell diameter; pallor wider than about one third of the diameter is hypochromia
- Inclusions: Howell-Jolly bodies, basophilic stippling, Pappenheimer bodies, nucleated red cells
The smear is examined in the monolayer, the thin part of the film where cells lie flat and are separated. Cells in the thick edge are distorted and should not be used to judge size, shape, or chromia.