An evaluation of existing manual blood film schistocyte quantitation guidelines and a new proposed method

Noutsos, Tina; Laidman, Alexandra Yasmin; Survela, Lesley; Arvanitis, Dorra; Brown, Simon G A

doi:10.1016/j.pathol.2021.01.008

Cited by 9 publications

(13 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Tool for Snakebite-Associated TMA Examination of the peripheral blood film for manual quantitation of schistocytes has diagnostic utility for TMA diagnosis in suspected snakebite. Two studies from Australia and India provide evidence supporting a role for schistocyte quantitation in snakebite [28,44,55]. This is in addition to several studies on the diagnostic utility of schistocyte quantitation for the diagnosis of TMA more broadly in non-snakebite settings [54,[56][57][58][59].…”

Section: Peripheral Blood Film Examination For Schistocyte Quantitation As a Diagnosticmentioning

confidence: 60%

“…Red cell morphological changes in microangiopathic haemolytic anaemia may also include micro-spherocytes (red arrows), which are secondarily derived from schistocytes, as defined by the International Council for Standardization in Haematology [53,54]. Derived from Noutsos et al [55].…”

Section: Snakebite Associated Tma Is Defined By Maha and Thrombocytopeniamentioning

confidence: 99%

“…Studies have shown that manual blood film schistocyte quantitation in Australian Findings on intra-and inter-observer agreement for blood film manual schistocyte quantitation show it is moderately reliable and reproducible, underscoring the importance of repeated blood film monitoring in the setting of suspected TMA in snakebite. Studies have shown that manual blood film schistocyte quantitation in Australian snakebite shows moderate to high reliability between different examining microscopists, and substantial to near perfect intra-observer agreement on repeated examinations by the same microscopist [55,[60][61][62][63]. Microscopists who are calibrated and trained can perform the procedure with reasonable inter-and intra-observer agreement.…”

Section: Peripheral Blood Film Examination For Schistocyte Quantitation As a Diagnosticmentioning

confidence: 99%

See 2 more Smart Citations

Snakebite Associated Thrombotic Microangiopathy and Recommendations for Clinical Practice

Noutsos

Currie

Wijewickrama

2022

Toxins

Self Cite

View full text Add to dashboard Cite

Snakebite is a significant and under-resourced global public health issue. Snake venoms cause a variety of potentially fatal clinical toxin syndromes, including venom-induced consumption coagulopathy (VICC) which is associated with major haemorrhage. A subset of patients with VICC develop a thrombotic microangiopathy (TMA). This article reviews recent evidence regarding snakebite-associated TMA and its epidemiology, diagnosis, outcomes, and effectiveness of interventions including antivenom and therapeutic plasma-exchange. Snakebite-associated TMA presents with microangiopathic haemolytic anaemia (evidenced by schistocytes on the blood film), thrombocytopenia in almost all cases, and a spectrum of acute kidney injury (AKI). A proportion of patients require dialysis, most survive and achieve dialysis free survival. There is no evidence that antivenom prevents TMA specifically, but early antivenom remains the mainstay of treatment for snake envenoming. There is no evidence for therapeutic plasma-exchange being effective. We propose diagnostic criteria for snakebite-associated TMA as anaemia with >1.0% schistocytes on blood film examination, together with absolute thrombocytopenia (<150 × 109/L) or a relative decrease in platelet count of >25% from baseline. Patients are at risk of long-term chronic kidney disease and long term follow up is recommended.

show abstract

Section: Peripheral Blood Film Examination For Schistocyte Quantitation As a Diagnosticmentioning

confidence: 60%

Section: Snakebite Associated Tma Is Defined By Maha and Thrombocytopeniamentioning

confidence: 99%

Section: Peripheral Blood Film Examination For Schistocyte Quantitation As a Diagnosticmentioning

confidence: 99%

See 1 more Smart Citation

Snakebite Associated Thrombotic Microangiopathy and Recommendations for Clinical Practice

Noutsos

Currie

Wijewickrama

2022

Toxins

Self Cite

View full text Add to dashboard Cite

show abstract

“…An evaluation was undertaken of the impact of the ICSH 2012 guidelines based on the analysis of citations in peer-reviewed papers published since 2012. [5][6][7][8][9][10] A search of PubMed on February 12, 2021, using the word "schistocytes," resulted in 433 references…”

Section: Me Thodsmentioning

confidence: 99%

“…Microspherocytes, which are small, deeply stained RBCs sometimes with protrusions but without sharp angles or straight borders, are included within the schistocyte count only when the RBC shapes mentioned above are present (Figure 1, red circle). To date, no alternative morphologic criteria for the identification of schistocytes by OM have been proposed, except for a recent report in which a more restrictive approach, limiting schistocyte count to helmet cells, triangular and crescent poikilocytes, 10 demonstrated "a near-perfect agreement" with the first 2012 ICSH Recommendations for identification, diagnostic value, and quantitation of schistocytes. It is hoped that there will be further studies of the robustness of the current morphological criteria in future.…”

Section: The Morphologic Rules To Identify Schistocytesmentioning

confidence: 99%

2021 update of the 2012 ICSH Recommendations for identification, diagnostic value, and quantitation of schistocytes: Impact and revisions

Zini

D’Onofrio

Erber

et al. 2021

Int J Lab Hematology

View full text Add to dashboard Cite

In 2012, the International Council for Standardization in Haematology (ICSH) published recommendations for the identification, quantitation, and diagnostic value of schistocytes. 1 This document was prepared due to the recognized need to harmonize schistocytes reporting within national hematology societies, most notably in France 2,3 and Italy. 4 It is freely available on the ICSH website (www.icsh.org).The 2012 ICSH recommendations focused on the microscope evaluation method, specific morphologic criteria for schistocyte identification and percentage calculation, definition of a threshold value in healthy subjects.

show abstract

Distinguishing and overlapping laboratory results of thrombotic microangiopathies in HIV infection: Can scoring systems assist?

Louw

Jacobson

Mayne

2022

J of Clinical Apheresis

View full text Add to dashboard Cite

Background: Patients with Human Immunodeficiency Virus (HIV) infection are at risk of thrombotic microangiopathies (TMAs) notably thrombotic thrombocytopenic purpura (TTP) and disseminated intravascular coagulation (DIC).Overlap between laboratory results exists resulting in diagnostic ambiguity. Methods: Routine laboratory results of 71 patients with HIV-associated TTP (HIV-TTP) and 81 with DIC with concomitant HIV infection (HIV-DIC) admitted between 2015 and 2021 to academic hospitals in Johannesburg, South Africa were retrospectively reviewed. Both the PLASMIC and the International Society of Thrombosis and Haemostasis (ISTH) DIC scores were calculated. Results: Patients with HIV-TTP had significantly (P < .001) increased schistocytes and features of hemolysis including elevated lactate dehydrogenase (LDH)/upper-limit-of-normal ratio (median of 9 (interquartile range [IQR] 5-12) vs 3 (IQR 2-5)) but unexpectedly lower fibrinogen (median 2.8 (IQR 2.2-3.4) vs 4 g/L (IQR 2.5-9.2)) and higher D-dimer (median 4.8 (IQR 2.4-8.1) vs 3.6 g/L (IQR 1.7-6.2)) levels vs the HIV-DIC cohort. Patients with HIV-DIC were more immunocompromised with frequent secondary infections, higher platelet and hemoglobin levels, more deranged coagulation parameters and less hemolysis. Overlap in scoring systems was however observed. Conclusion:The laboratory parameter overlap between HIV-DIC and HIV-TTP might reflect a shared pathogenesis including endothelial dysfunction and inflammation and further research is required. Fibrinogen in DIC may be elevated as an acute phase reactant and D-dimers may reflect the extensive hemostatic activation in HIV-TTP. Inclusion of additional parameters in TMA scoring systems such the LDH/upper-limit-of-normal ratio, schistocytes count

show abstract

An evaluation of existing manual blood film schistocyte quantitation guidelines and a new proposed method

Abstract: Pathology (-xxxx) xxx(xxx), xxx Please cite this article as: Noutsos T et al., An evaluation of existing manual blood film schistocyte quantitation guidelines and a new proposed method, Pathology,

Cited by 9 publications

References 21 publications

Snakebite Associated Thrombotic Microangiopathy and Recommendations for Clinical Practice

Snakebite Associated Thrombotic Microangiopathy and Recommendations for Clinical Practice

2021 update of the 2012 ICSH Recommendations for identification, diagnostic value, and quantitation of schistocytes: Impact and revisions

Distinguishing and overlapping laboratory results of thrombotic microangiopathies in HIV infection: Can scoring systems assist?

Contact Info

Product

Resources

About