Microscopic schistocyte determination according to International Council for Standardization in Hematology recommendations in various diseases

Huh, Hee Jae; Chung, Jae-Woo; Chae, Seok Lae

doi:10.1111/ijlh.12059

Cited by 24 publications

(38 citation statements)

References 17 publications

(25 reference statements)

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“…However, in the majority of the aforementioned conditions, schistocytes were observed in conjunction with additional moderate RBC abnormalities. This is consistent with the findings of Huh et al [1]. Schistocytes in neonates are not pathological.…”

Section: Discussionsupporting

confidence: 94%

“…A higher percentage is usually found in preterm neonates owing to liver immaturity. However, in this study, the term neonates presented with concomitant conditions that resulted in a slightly higher percentage than previously reported [1]. …”

Section: Discussioncontrasting

confidence: 63%

“…The presence of schistocytes on a peripheral blood smear (PBS) according to laboratory policies is a hematological emergency that requires prompt review and investigation for thrombotic microangiopathy (TMA). Schistocytes, however, are not specific to TMA [1]. Fragmentation of RBCs is produced by mechanical damage in the circulation and can also be seen in patients with mechanical heart valves or those receiving dialysis.…”

Section: Introductionmentioning

confidence: 99%

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The Clinical Significance of Schistocytes: A Prospective Evaluation of the International Council for Standardization in Hematology Schistocyte Guidelines

Schapkaitz

Mezgebe²

2017

Tjh

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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.

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Section: Discussionsupporting

confidence: 94%

Section: Discussioncontrasting

confidence: 63%

Section: Introductionmentioning

confidence: 99%

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The Clinical Significance of Schistocytes: A Prospective Evaluation of the International Council for Standardization in Hematology Schistocyte Guidelines

Schapkaitz

Mezgebe²

2017

Tjh

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“…Precise morphological criteria for the recognition and enumeration of schistocytes have been provided by the ICSH and aim to decrease the variability in the morphological interpretation and reporting between laboratories and observers. A recent study supports the recommendations provided by the ICSH, and a French survey has shown that the will to implement validated recommendations was strong, reflecting the awareness of the biologists to standardize the laboratory investigations [5,6].…”

mentioning

confidence: 77%

Automated microscopy could decrease intra‐ and interobserver variation in microscopic schistocyte quantitation

Maenhout

Marcelis

2014

Int J Lab Hematology

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“…5 Schistocytes can also be found in non-TMArelated disorders and conditions such as thalassaemia and inherited red blood cell (RBC) membrane defects, and as a consequence of mechanical damage from prosthetic heart valves, structural abnormalities of great vessels, and malignant hypertension. [6][7][8] Schistocytes identified in peripheral blood smears of non-TMA-related diseases are usually just one of many RBC shape abnormalities. 5 The gold standard for the identification of schistocytes is microscopic evaluation by well-trained personnel.…”

Section: Introductionmentioning

confidence: 99%

Comparison between optical microscopy and the Sysmex XN‐3000 for schistocyte determination in patients suspected of having schistocytosis

Hantaweepant

Sasijareonrat

Chutvanichkul

et al. 2019

Health Science Reports

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Background and aims Diagnosis of thrombotic microangiopathy (TMA) relies on microscopic schistocyte determination by an experienced microscopist. In addition, schistocytes can be found in non‐TMA–related disorders such as thalassaemia. We aimed to compare the accuracy of the automated haematology analyser Sysmex XN‐3000 for schistocyte detection, to that of the microscopy approach, in patients suspected of having schistocytosis. Methods Consecutive blood samples were collected between April 2016 and March 2017 at Siriraj Hospital, Mahidol University, Bangkok, Thailand. Specimens were collected from adults with suspected TMA or with thalassaemia trait and/or disease. All blood samples were examined by both microscopy and the analyser. Samples were considered to be positive for schistocytes (ie, schistocytosis) if they had a schistocyte count ≥1% by microscopy. The analyser's ability to determine schistocytosis was assessed by receiver operating characteristic (ROC) curve. Sensitivity, specificity, positive (PPV), and negative predictive value (NPV) of an appropriate cut‐off point were calculated, with manual microscopy as the standard. Quantitative agreement in schistocyte counts between the two approaches was assessed using 95% limits of agreement, Bland‐Altman plots, intraclass correlation coefficient, and concordance correlation coefficient. Results Ninety‐seven blood samples (62 suspected TMA and 35 thalassaemia) were collected. ROC curve analysis of the analyser for determining schistocytosis showed an area under the curve of 0.803 (95% confidence interval, 0.689‐0.917, P < 0.001). A cut‐off point of 0.6% yielded 86.1% sensitivity, 77.8% specificity, 94.4% PPV, and 56.0% NPV. The automated schistocyte count did not quantitatively agree with schistocyte counts by microscopy, neither in all blood specimens (mean of difference: −1.09; 95% limits of agreement, −11.9 to 9.7) nor in the subgroups (TMA, −0.88; 95% limits of agreement, −6.60 to 4.84; thalassaemia, −2.4; 95% limits of agreement, −14.10 to 9.30). The differences in the estimation of fragmented red blood cells between the methods tended to increase at higher schistocyte counts. Conclusion Sysmex XN‐3000 can be used for qualitative measurement of schistocytosis, but should not be used as a quantitative tool for schistocyte counting. Improvements are needed before this analyser's schistocyte detection feature can be recommended for use in clinical practice.

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Microscopic schistocyte determination according to International Council for Standardization in Hematology recommendations in various diseases

Cited by 24 publications

References 17 publications

The Clinical Significance of Schistocytes: A Prospective Evaluation of the International Council for Standardization in Hematology Schistocyte Guidelines

The Clinical Significance of Schistocytes: A Prospective Evaluation of the International Council for Standardization in Hematology Schistocyte Guidelines

Automated microscopy could decrease intra‐ and interobserver variation in microscopic schistocyte quantitation

Comparison between optical microscopy and the Sysmex XN‐3000 for schistocyte determination in patients suspected of having schistocytosis

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