Schistocytes in disseminated intravascular coagulation

Lesesve, Jean‐François; Martin, Myriam; Banasiak, C.; André-Kerneïs, Elisabeth; Bardet, Valérie; Lusina, Daniel; Kharbach, Aicha; Geneviève, Franck; Lecompte, Thomas

doi:10.1111/ijlh.12168

Cited by 37 publications

(36 citation statements)

References 13 publications

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“…The mean schistocyte percentages of PBSs from cases of TTP (n=68), HUS (n=1), DIC (n=1), and HELLP (n=5) were 3.51±1.88%, 3.50%, 4.1%, and 2.42±1.6%, respectively. Schistocytes in DIC are frequently observed at lower percentages [8]. In this study, the patient with DIC had concomitant conditions associated with increased schistocytes such as metastatic carcinoma and severe postoperative infection.…”

Section: Resultsmentioning

confidence: 79%

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: Resultsmentioning

confidence: 79%

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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“…In our study, 29% of CBCs with a very high FRC were from neonates who had DIC. Indeed schistocytosis is common in DIC, and following the FRC in neonates with DIC could be a useful marker for improvement or worsening [17,18].…”

Section: Discussionmentioning

confidence: 99%

Automated Quantification of Fragmented Red Blood Cells: Neonatal Reference Intervals and Clinical Disorders of Neonatal Intensive Care Unit Patients with High Values

et al. 2018

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Background: Schistocytes are circulating erythrocyte fragments. They can be identified microscopically from a blood smear; but automated systems evaluate more cells and avoid inconsistencies in microscopy. Studies using adult subjects indicate that automated quantification of schistocytes can be clinically useful. However, reference intervals for automated schistocyte counts of neonates have not been published, and the relevance of a high automated schistocyte count from neonates has not been reported. Objectives: Using retrospective automated neonatal complete blood count (CBC) data, we created reference intervals for fragmented red cells (FRCs) and sought to discover the clinical conditions of neonates with high FRCs (above the upper reference interval). Results: We created reference intervals based on 39,949 CBCs from 15,655 neonates 0–90 days old. The lower reference interval was 0 FRC/µL and the upper interval was 100,000/µL. The highest FRCs (96 CBCs from 44 neonates) were > 250,000/µL. These neonates clustered into the following groups: 37% had sepsis, 29% had disseminated intravascular coagulation (DIC), 17% had a genetic syndrome, 14% necrotizing enterocolitis (NEC), and 7% had iron deficiency (some had more than one diagnosis). Based on the reference intervals, we divided the 39,949 FRC values into 3 groups: (1) < 100,000/µL (“normal”), (2) 100,000–200,000/µL (“moderately elevated”), and (3) > 200,000/µL (“extremely elevated”). The odds that a microangiopathic condition (DIC, sepsis, NEC) or a microcytic disorder (iron deficiency) were present were significantly higher in the moderately elevated, and more so in the extremely elevated group. Conclusions: Our study suggests that a high FRC could prompt investigation into, or inform follow-up of, a neonatal microangiopathic or extremely microcytic disorder.

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“…Thermal injury results in the direct destruction of red blood cells within skin capillaries leading to the appearance of FRC, commonly referred to as microspherocytes 20 . FRC are products of erythrocyte lysis present in a number of pathological conditions but almost completely absent in healthy individuals 21, 22 . Due to the nature and variation in size of FRC quantification has been extremely difficult and has traditionally relied upon visual examination of blood films 23 .…”

Section: Discussionmentioning

confidence: 99%

Changes in novel haematological parameters following thermal injury: A prospective observational cohort study

Dinsdale

Devi

Hampson

et al. 2017

Sci Rep

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The mortality caused by sepsis is high following thermal injury. Diagnosis is difficult due to the ongoing systemic inflammatory response. Previous studies suggest that cellular parameters may show promise as diagnostic markers of sepsis. The aim of this study was to evaluate the effect of thermal injury on novel haematological parameters and to study their association with clinical outcomes. Haematological analysis was performed using a Sysmex XN-1000 analyser on blood samples acquired on the day of the thermal injury to 12 months post-injury in 39 patients (15–95% TBSA). Platelet counts had a nadir at day 3 followed by a rebound thrombocytosis at day 21, with nadir values significantly lower in septic patients. Measurements of extended neutrophil parameters (NEUT-Y and NEUT-RI) demonstrated that septic patients had significantly higher levels of neutrophil nucleic acid content. A combination of platelet impedance count (PLT-I) and NEUT-Y at day 3 post-injury exhibited good discriminatory power for the identifying septic patients (AUROC = 0.915, 95% CI [0.827, 1.000]). Importantly, the model had improved performance when adjusted for mortality with an AUROC of 0.974 (0.931, 1.000). A combination of PLT-I and NEUT-Y show potential for the early diagnosis of sepsis post-burn injury. Importantly, these tests can be performed rapidly and require a small volume of whole blood highlighting their potential utility in clinical practice.

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Schistocytes in disseminated intravascular coagulation

Cited by 37 publications

References 13 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 Quantification of Fragmented Red Blood Cells: Neonatal Reference Intervals and Clinical Disorders of Neonatal Intensive Care Unit Patients with High Values

Changes in novel haematological parameters following thermal injury: A prospective observational cohort study

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