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[quote=Anonymous][quote=Anonymous][quote=Anonymous]^ It will not let me quote you for some reason, but read the third link again. The third link did study the accuracy of peripheral blood smears on those with sickle cell disease (not just sickle cell trait). Peripheral blood smears were found to have diagnosed all cases of sickle cell disease accurately with 100% sensitivity and specificity.

https://www.rmj.org.pk/fulltext/27-1594051429.pdf[/quote]

Because they were using special staining and then -- most importantly -- electrophoresis. That is not the same thing as just looking at morphology of cells; rather, that is specific for assessing the actual type of hemoglobin within the cell. You see the difference?

In the methodology:

[quote]Questionnaires were filled after interview and after all aseptic measures, 2 ml intravenous blood was collected in Ethylene Diamine Tetra Acetic Acid anticoagulated tubes (Purple Top). The samples were shifted to Dow Ishrat-ul-Ebad Khan Institute of Blood diseases (DDRRL) maintaining the cold chain and [b]peripheral smears were prepared and stained using Leishman stain. Genio-S interlab (Italy) was utilized for hemoglobin electrophoresis[/b] at pH of 8.6 using cellulose acetate as a medium. [/quote]

That's the only way you make it to 100% sensitivity, but that was not what we were discussing, I mean, it's great, but it's just not true that you will always find sickle cells in every sample from someone with SCA, much less SCT. However, you can do additional more complicated (and more expensive, more time-consuming) tests to do that -- but then we are back to not being able to rely on a simple peripheral smear viewed under a microscope. Because that isn't enough.

This is the electrophoresis process:

Test Details
What Is Hemoglobin Electrophoresis?
Hemoglobin electrophoresis is a test to check hemoglobin protein in your red blood cells. Hemoglobin is a protein in your red blood cells that helps cells carry oxygen throughout your body. A provider may do this test to diagnose blood disorders. It’s also one of several screening tests for newborns.

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Hemoglobin types
There are five hemoglobin types:

Type A (HgbA): Hemoglobin A accounts for most of the hemoglobin in your normal red blood cells.
Type A2 (HgbA2): This type accounts for about 2% to 3 % of your total hemoglobin.
Type F (HgbF): High levels are normal in fetuses, babies and children up to 3 years old. High type F levels in older children and adults may be signs of blood disorders or other health issues.
Type S (HgbS): This type is a sign of sickle cell anemia.
Type C (HgbC): This type C is a sign of hemolytic anemia.
Test Details
How does the test work?
A venous blood draw is the most common way providers get blood samples for analysis. Other procedures are:

Finger stick: Your healthcare provider pricks your fingertip to get a tiny sample of your blood. Your child’s healthcare provider may use a finger stick test to get a blood sample.
Heel stick: A provider gets a few drops of blood by pricking your baby’s heel with a needle. They do this test to check for sickle cell anemia.
You don’t need to prepare for this blood test.

[quote]What are the steps in hemoglobin electrophoresis?
This test uses electricity to separate hemoglobin types. That process involves the following steps:

1. A technician places dissolved red blood cells on a cellulose strip.
2. They put the strip into a machine that passes electricity through the red blood cells.
3. The hemoglobin types react to the current by separating into separate bands.
4. The technicians compare the test results with normal hemoglobin.

https://my.clevelandclinic.org/health/diagnostics/22420-hemoglobin-electrophoresis[/quote]
[/quote]
Yes, they used stain to allow for identification of the various cell types. They need to be able to correctly differentiate and identify. This is a common practice when doing peripheral blood smears.

The electrophoresis was done because they were evaluating the accuracy of peripheral blood smears in diagnosing sickle cell by comparing the peripheral blood smear results with electrophoresis results.

Their objective says, “To evaluate the diagnostic accuracy of peripheral smear morphology as a screening tool for Sickle cell trait/disease by comparing its results with hemoglobin electrophoresis.”[/quote]

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