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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Turk+J+Haematol
2017 ; 34
(1
): 59-63
Nephropedia Template TP
Turk J Haematol
2017[Mar]; 34
(1
): 59-63
PMID27795225
show ga
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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