BUsmear: A Low-Cost 3D-Printed Automated Device for Blood Smear Preparation

Uniform, reproducible blood smears are critical for reliable hematological evaluation. Manual smear preparation, however, is user-dependent and introduces variability that limits quantitative microscopy. Here we developed BUsmear, a low-cost, 3D-printed, motorized blood smear device that prepares two smears simultaneously from a printed stage and a micro-motor drive with tunable linear velocity, controlled through a joystick-operated driver module. By spreading two slides in parallel with fully repeatable slide-to-slide motion, the device doubles throughput while eliminating operator-dependent motion artifacts, and can be fabricated on any benchtop 3D printer in under one day. To validate smear quality, we analyzed blood films from three donors together with a manual smear prepared by an expert from the blood of one of the same donors, giving a matched device-versus-manual pair. Automated Cellpose segmentation of 14,046 red blood cells across 12 bright-field fields showed that cell diameter was preserved and closely matched the expert smear (6.7-7.8 um across groups, within the 6.2-8.2 um human reference range; 6.7 vs 6.9 um in the matched pair), and that all films formed non-aggregated monolayers (Clark-Evans index of aggregation 1.04-1.24). Critically, red blood cells in the device films were markedly more circular than in the expert manual smear (mean eccentricity 0.405 vs 0.502; 0.443 vs 0.502 in the matched pair), with complete separation between the two methods at the level of whole fields of view. Because eccentricity reports smear-induced cell distortion, this indicates that a constant, mechanically controlled spreading velocity preserves red blood cell morphology better than skilled manual technique. BUsmear offers an accessible route to standardized smear geometry for quantitative analysis, including AI-based morphometry, and its low cost may be particularly advantageous in low-income countries with a high prevalence of malaria.