Fragmented red blood cells automated measurement is a useful parameter to exclude schistocytes on the blood film

Lesesve, Jean‐François; Asnafi, Vahid; Braun, Françoise; Zini, Gina

doi:10.1111/j.1751-553x.2012.01434.x

Cited by 35 publications

(46 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…An overestimation of the schistocyte count was also noted in the presence of anisopoikilocytosis. This is consistent with other reports that found that the ADVIA and Sysmex (Roche Diagnostics, Kobe, Japan) analyzers underestimated the schistocyte count after a threshold of 1.5% [6,7,14]. However, conditions such as hemoglobinopathies and renal failure represented a small percentage of the study population.…”

Section: Discussionsupporting

confidence: 92%

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

Schapkaitz

Mezgebe²

2017

Tjh

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 92%

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

Schapkaitz

Mezgebe²

2017

Tjh

View full text Add to dashboard Cite

show abstract

“…Thus, the FRC parameter could be particularly useful from automated CBCs. However, even when a manual differential count is performed, there is technician variation in reporting schistocytes [5]. Table 3 illustrates this variation in our own data, indicating that when the FRC is very high, schistocytes and other abnormally shaped RBC forms are not always reported.…”

Section: Discussionmentioning

confidence: 82%

“…Certainly the FRC count does not represent an automated count of schistocytes only, and if a precise schistocyte evaluation is needed, a film review is needed. However, in studies of adults, automated and manual values tended to correlate well [5,[23][24][25]. Also, we had relatively few very premature neonates in our database.…”

Section: Discussionmentioning

confidence: 90%

“…For instance, from 1,366 CBCs of healthy French adults, Lesesve et al [5] found that the highest FRC value was 4% and the mean value was 0.14%. In contrast, our highest value was > 20% and our mean value about 1.5%.…”

Section: Discussionmentioning

confidence: 99%

“…However, subjectivity in assessing schistocytes, and the relatively small sample sizes technologists generally survey to make this determination render this type of semi-quantitative scoring imprecise and inconsistent [4][5][6]. These limitations are well known to the International Council for Standardization in Hematology [7].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

View full text Add to dashboard Cite

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.

show abstract

Performing a Blood Count

Bain¹

2014

Blood Cells

View full text Add to dashboard Cite

Fragmented red blood cells automated measurement is a useful parameter to exclude schistocytes on the blood film

Abstract: Our study validated the utility of the immediately available FRC parameter on ABCC to exclude schistocytes and the diagnosis of TMA.

Cited by 35 publications

References 18 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

Performing a Blood Count

Contact Info

Product

Resources

About