Skip to main content Skip to main navigation menu Skip to site footer

The stability of sample storage for complete blood count (CBC) toward the blood cell morphology

  • Arie Rahmanitarini ,
  • Yetti Hernaningsih ,
  • Yulia Nadar Indrasari ,


Background: Peripheral blood smear examination had a pivotal role in determining diagnosis and as confirmation of the automatic hematology analyzer results. The storage process was highly influential on the morphological stability of the cell. This study aimed to assess the morphological changes in blood cells stored at certain period and temperature.

Method: Sample of 30 blood specimens of healthy people with dipotassium ethylenediaminetetraacetic acid (K2EDTA) anticoagulants. The specimens were stored at room temperature (18-25ºC) and refrigerator temperature (2-8ºC) and were analyzed at the preliminary examination i.e., 8 hours, 16 hours, 24 hours, 48 hours, 72 hours, and 96 hours. Kappa test was used in validating the reading of PBS (Peripheral Blood Smear). The discrimination testing used were paired t-test and Kolmogorov Smirnov test with p value <0.005, which stated to be significant. 

Result: The changes in erythrocytes morphology stored at room temperature (18-25ºC) was that the erythrocytes crenation started to happen at 8 hours storage with the grading scale of +2 that were found in 24 (80%) samples, whereas at refrigerator temperature (2-8ºC) the grading scale was +1 and found in 13 (43.3%) samples. Spherocytes on erythrocytes began to form at room temperature (18-25ºC) at 8 hours storage with grading scale of +1 and was found in 2 (6.7%) samples, whereas at refrigerator temperatures (2-8ºC) spherocytes on erythrocytes began to form at 24 hours storage with grading scale of + 2 and was found in 3 (10%) samples.

Conclusion: Peripheral blood smear (PBS) examination shall be done immediately to obtain significant results.


  1. Antwi-Baffour S, Quao E, Kyeremeh R. Prolong store of blood in EDTA has an the effect on the morphology and osmotic fragility of erythrocyte. International Journal of Biomedical Science and Engineering. 2013; 1(2):20-23.
  2. Rodak BF, Fritsma GA, and Keohane FA. Hematology, Clinical Principles and Application 4th ed Elsevier Saunder. 2016: 176-180
  3. Bain BJ, Bates I, Laffan MA, Lewis SM. Dacie & Lewis Practical Hematology, 11Th ed. Churchill Livingstone. 2013: 56-67.
  4. Palmer L, Briggs C, McFadden, Zinni G, Burthem J, Rozenberg G, et al. ICSH recommendations for the standardization of nomenclature and grading of peripheral blood cell morphological features. Int J Lab Hematol. 2015; 37(3):287-303
  5. Turgeon ML. Basic Laboratory Assessment of Erythrocytes, Leukocytes, and Platelets. Clinical Hematology Theory and Procedures. 6th Ed. Philadephia: Wolter Kluwer. 2018: 209-29.
  6. Hilman RS, Ault KA,Rinder HM. Normal erythropoesi : Hematology in Clinical Practice. 4th Ed. McGraw Hill. 2005: 34-78
  7. Narayana S. The preanalytic phase. An important component of laboratory medicine. Am J Clin Pathol. 2000; 113(3):429-52.
  8. De Baca M, Gulati G, Kocher W, Schwarting R. Effect of Storage of Blood at Room Temperature on Hematologic Parameter Measured on Sysmex XE2100. Lab Med 2006; 37(1)28-36
  9. Gulati GL, Hyland LJ, Kocher W, Schwarting R. Change in automated complete blood cell count and differential count result induced by storage of blood at room temperature. Arch Pathol Lab Med. 2002; 126(3):336-42
  10. Zini G1; International Council for Standardization in Haematology (ICSH). Stability of Complete Blood Count Parameter with Storage: toward defined specification for different diagnostic application. Int J Lab Hematol. 2014; 36(2):111-3
  11. Robibins, Vinay Kumar, Abul K, Abbas, Aster. Buku Ajar Patologi. Edisi 9 Elsevier. 2015: 34-109.
  12. Tatsumi N, Miwa S, Lewis SM, International Society of Hematology, and the International Council for Standardization in Haematology. Specimen collection, storage, and transmission to the laboratory for hematological tests. Int J Hematol 2002; 75(3):261–8.
  13. Vives-Corrons JL, Briggs C, Simon-Lopez R, Albarede S, de la Salle B, Flegar-Meatrii Z et al. Effect of EDTA-anticoagulated whole blood storage on cell morphology examination. A need for standardization. Int J Lab Hematol. 2014; 36(2):222-6
  14. Lestari AAW, Karyana IPSR, Wande IN. Difference in sodium and potassium reading by blood gas analyzer and electrolyte analyzer at Sanglah Hospital Denpasar, Bali, Indonesia. Journal of Global Pharma Technology. 2018; 10(7):44-48
  15. Mulyantari NK, Prabawa IPY. Analysis of Soluble Cluster of Differentiation 40 Ligand (SD40L) levels between thrombocyte apheresis and thrombocyte whole blood products in Sanglah General Hospital blood bank. Bali Med J. 2019; 8(1):173-78

How to Cite

Rahmanitarini, A., Hernaningsih, Y., & Indrasari, Y. N. (2019). The stability of sample storage for complete blood count (CBC) toward the blood cell morphology. Bali Medical Journal, 8(2), 482–486.




Search Panel

Arie Rahmanitarini
Google Scholar
BMJ Journal

Yetti Hernaningsih
Google Scholar
BMJ Journal

Yulia Nadar Indrasari
Google Scholar
BMJ Journal