Rapid Identification of Thrombocytopenia-Associated Multiple Organ Failure Using Red Blood Cell Parameters and a Volume/Hemoglobin Concentration Cytogram

Abstract

Thrombocytopenia-associated multiple organ failure (TAMOF) has a high mortality rate when not treated, and early detection of TAMOF is very important diagnostically and therapeutically. We describe herein our experience of early detection of TAMOF, using an automated hematology analyzer. From 498,390 inpatients, we selected 12 patients suspected of having peripheral schistocytosis, based on the results of red blood cell (RBC) parameters and a volume/hemoglobin concentration (V/HC) cytogram. We promptly evaluated whether the individual patients had clinical manifestations and laboratory findings were consistent with TAMOF. Plasma exchanges were then performed for each patient. All 12 patients had TAMOF. The mean values of RBC parameters were significantly higher in all of the patients than with the reference range, however, 3 patients had % RBC fragments within the reference range. The mean value of ADAMTS-13 activity was slightly lower in patients compared with the reference range. Of the 12 patients, remission was obtained in 9 patients (75%) within 4 to 5 weeks using plasma exchanges. Three patients died. An increased percentage of microcytic hyperchromic cells with anisocytosis and anisochromia indicated the presence of schistocytes, making it an excellent screening marker for TAMOF. Identification of TAMOF with RBC parameters and a V/HC cytogram is a facile and rapid method along with an automated hematology analyzer already in use for routine complete blood cell counting test.

Thrombotic thrombocytopenic purpura: A 5‐year tertiary care centre experience

“…Monitoring of haemoglobin level, platelet counts, LDH, and peripheral blood smear schistocyte counts were also used as reliable therapeutic end points to monitor the effectiveness of TPE therapy ( P < .05). While LDH levels have not been shown to be a useful determinant of treatment duration in all studies, the red cell distribution width has consistently been found to be an excellent monitoring tool for the presence of schistocytes …”

“…While LDH levels have not been shown to be a useful determinant of treatment duration in all studies, 21 the red cell distribution width has consistently been found to be an excellent monitoring tool for the presence of schistocytes. 22 The management of TTP at academic centres in SA has been previously published. [4][5][6] In the absence of local guidelines, the management varies between centres.…”

Thrombotic Microangiopathy Score as a New Predictor for Neurologic Outcome in Patients Undergoing Targeted Temperature Management After Out-of-hospital Cardiac Arrest

“…The International Council for Standardization in Hematology (ICSH) Schistocyte Working Group recommended that the more than 1% schistocytes on a peripheral blood smear is an important criterion for identifying TMA [13]. Moreover, the occurrence of schistocytes in blood re ects a high risk of thrombocytopenia-associated multiple organ failure (TAMOF) [17]. Schistocytes indicate speci c characteristics of increased red cell distribution width (RDW) and hemoglobin distribution width (HDW), and microcytic hyperchromic red blood cells (RBCs) [15,17].…”

“…Moreover, the occurrence of schistocytes in blood re ects a high risk of thrombocytopenia-associated multiple organ failure (TAMOF) [17]. Schistocytes indicate speci c characteristics of increased red cell distribution width (RDW) and hemoglobin distribution width (HDW), and microcytic hyperchromic red blood cells (RBCs) [15,17]. Based on the development and changes in the morphological characteristics of schistocytes, the TMA score was developed as a rapid, simple marker to screen for TAMOF in critically ill patients [15].…”

“…Based on the development and changes in the morphological characteristics of schistocytes, the TMA score was developed as a rapid, simple marker to screen for TAMOF in critically ill patients [15]. An automated complete blood cell (CBC) analyzer can automatically and easily determine the TMA score based on RBC parameters and the volume/hemoglobin concentration (V/HC) [15,17].…”