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Objective:The presence of ≥1% schistocytes on a peripheral blood smear (PBS) is an important criterion for the diagnosis of thrombotic microangiopathy (TMA). The reporting of schistocytes has been standardized by the International Council for Standardization in Hematology (ICSH). Despite the availability of guidelines, however, the assessment of schistocytes remains subjective. More recently, the automated fragmented red cell (FRC) parameter has been evaluated. However, local studies are not available.Materials and Methods:A prospective study was performed at the Charlotte Maxeke Johannesburg Academic Hospital in order to evaluate the ICSH recommendations for schistocyte measurement in 146 PBSs with schistocytes. Schistocytes were evaluated by microscopy and ADVIA 2120 automated hematology analyzers.Results:Schistocytes were frequently observed in patients with TMA (n=76), infection (n=20), hematologic malignancy (n=10), renal failure (n=5), and hemoglobinopathy (n=15), and in neonates (n=11). Schistocytes were ≥1% in all PBSs with TMA (n=76) with a mean of 3.44±1.84. Schistocytes of ≥1% were also observed in cases of renal failure and hemoglobinopathy, and in neonates. In these conditions, schistocytes were mainly observed in conjunction with moderate red blood cell changes. The agreement between two morphologists gave a correlation coefficient of 0.63 [confidence interval (CI): 0.52-0.75], while the correlation coefficient between the average of the morphologists and the FRC percentage was -1.97 (CI: -1.60 to -2.34). The ADVIA 2120 underestimated the schistocyte count in patients with TMA.Conclusion:Observer bias can be decreased by implementing the standardized procedures recommended by the ICSH. However, estimation of schistocytes by the ADVIA 2120 analyzer requires further evaluation as a screening tool. A higher threshold for schistocytes in thrombotic thrombocytopenic purpura is recommended to distinguish this hematological emergency from other conditions associated with ≥1% schistocytes.

The new reticulocyte and erythrocyte parameters are reliable tests for the diagnosis of subclinical ID in pregnant patients. Further studies, however, are required to confirm the diagnostic utility of the erythrocyte parameters in pregnant patients. These tests will benefit the management of pregnant patients attending antenatal clinic.

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This study demonstrated differences in ESR results, predominantly at extremes of the analytical range, using an alternate method. Careful consideration and performance monitoring of these novel methods are advised.

Introduction Thrombotic thrombocytopenic purpura (TTP) is associated with high mortality if not managed timeously with therapeutic plasma exchange (TPE). TTP secondary to human immunodeficiency virus (HIV) infection is unique to sub‐Saharan Africa. The management and outcome of TTP in the era of improved access to therapy has not been described. Methods The present study describes the clinical presentation, treatment, therapeutic endpoints, and outcome of TTP patients at the Charlotte Maxeke Johannesburg Academic Hospital, South Africa. The inpatient and outpatient records of 41 consecutive adults with TTP were reviewed between 2012 and 2016. Patients were classified according to aetiology and treatment response. Results TTP was the initial presenting feature of HIV infection in 78.0%, and 12.5% were noncompliant with antiretroviral therapy (ART). Most study patients were of black ethnicity (95%) and female gender (78.1%). Treatment included initial TPE (87.8%), plasma infusion (78.1%), antiretroviral therapy (78.3%), corticosteroids (61.0%) intensive care admission (41.5%), renal dialysis (12.2%), and other immunosuppressive agents (4.9%). The median (range) number of TPEs was 10.0 (7.0‐15.0). A high rate of refractory disease (63.4%) was reported. Haemoglobin, platelet count, lactate dehydrogenase, red cell distribution width, and creatinine were reliable therapeutic end‐points (P < .05). The relapse rate was 9.8% and the mortality rate was 29.3%. Conclusion The high mortality rate emphasises the importance of early diagnosis, referral, and appropriate management of TTP. Anti‐retroviral therapy and adherence monitoring are essential to TTP management associated with HIV. Future studies to identify patients at risk for refractory disease are indicated.

RESEARCHBackground. Venous thromboembolism (VTE) is associated with considerable morbidity and mortality in the absence of thromboprophylaxis. Method. The Southern African Society of Thrombosis and Haemostasis reviewed the available literature and comprehensive evidencebased guidelines on the prevention of VTE in obstetrics and gynaecology. A draft document was produced and revised by consensus agreement by a panel of professionals from various specialties. The recommendations were adjudicated by an independent international expert to avoid local bias. Results and conclusion. We present concise, practical thromboprophylaxis guidelines for the clinical management of patients in obstetrics and gynaecology. Recommendations reflect current best practice, which it is hoped will lead to improved anticoagulation practice in this group of patients. Venous thromboembolism (VTE) is associated with considerable morbidity, and mortality in the absence of thromboprophylaxis. Pulmonary embolism (PE) is the leading cause of maternal death worldwide. S Afr J Obstet Gynaecol[1] Further, PE is the cause of ~20% of deaths following hysterectomy.[2] The prevalence of deep vein thrombosis (DVT) in patients having major gynaecologic surgery ranges between 15% and 40%. [3] There are a few randomised trials to guide the management of this group of patients. Recommendations in this guideline therefore reflect current best practice. Management should be individualised according to the risk-benefit ratio and cost. MethodsOn behalf of the Southern African Society of Thrombosis and Haemostasis, a representative guideline panel of professionals from various specialities reviewed the available literature on the prevention of VTE in obstetrics and gynaecology. Recommendations presented are in accordance with the more comprehensive evidence-based guidelines namely the 9th edition of the American College of Chest Physicians (ACCP), [4] the Green Top guidelines of the Royal College of Obstetricians and Gynaecologists (RCOG), [5] the American College of Obstetricians and Gynecologists (ACOG), [6] the Society of Obstetricians and Gynaecologists of Canada (SOGC), [7] Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) [8] and the European Society of Regional Anaesthesia (ESRA) Guidelines on Anticoagulation and Regional Anaesthesia.[9] Many of these recommendations are formulated in the absence of strong evidence and the guidelines were also prepared in conjunction with systematic reviews and observational studies. A draft document was produced and revised by consensus agreement. The guidelines were adjudicated and co-authored by an independent international expert to avoid local bias. VTE in gynaecology Oestrogen and VTE riskOestrogen use increases the risk of VTE as a class effect which is dose dependant.[10] The risk of VTE is dependent on the route of administration. There is lower associated risk with transdermal and intra-uterine hormonal therapy as well as the progesterone-only oral contraceptive. [11,12] Gynaecological surgery...