Lesesve J-F, Asnafi V, Braun F, Zini G
Laboratory of Hematology, University Hospital, Nancy, FranceLaboratory of Hematology, Hospital Necker - Enfants malades, Paris, FranceLaboratory of Hematology, Hospital Center, Thionville, FranceHematology Laboratory, Catholic University of Sacred Heart, Rome, ItalyResearch Center for Automated Hematology (ReCamh), Roma, Italy.
Int J Lab Hematol. 2012 Dec;34(6):566-76. doi: 10.1111/j.1751-553X.2012.01434.x. Epub 2012 Jun 14.
The diagnosis of thrombotic microangiopathies (TMA) or disorders that may mimic their features remains difficult. Mechanical hemolytic anemia with the detection of shistocytes on the blood smear is a cornerstone finding to assess the diagnosis, but microscopic evaluation of shistocytes is still problematic with wide interobserver variations. Some of the latest generation automated blood cell counters (ABCC) propose an original quantitative approach of fragmented red cells (FRC), aiming to be equivalent to the microscopic count. This parameter has been poorly evaluated.
To assess the predictive value (PV) of this test, we conducted studies comparing automated and microscopic counts of FRC/schistocytes, based on the analysis of thousands samples in four university hospitals and using the 2 ABCC currently available (Siemens ADVIA series, Sysmex XE-2100).
Reference range for FRC was <0.3% for the ADVIA and <0.5% for the XE-2100. The presence of FRC below a threshold determined at 1% (ADVIA and XE-2100) had a negative PV close to 100% to exclude the presence of schistocyte on the blood smear, but in relationship with a poor PV value.
Our study validated the utility of the immediately available FRC parameter on ABCC to exclude schistocytes and the diagnosis of TMA.
血栓性微血管病（TMA）或可能具有类似特征的疾病的诊断仍然困难。血液涂片上检测到裂细胞的机械性溶血性贫血是评估诊断的一项关键发现，但裂细胞的显微镜评估仍存在问题，观察者间差异很大。一些最新一代的自动血细胞计数器（ABCC）提出了一种原始的破碎红细胞（FRC）定量方法，旨在等同于显微镜计数。该参数评估不足。
为评估该检测的预测价值（PV），我们基于对四家大学医院数千份样本的分析，并使用现有的2种ABCC（西门子ADVIA系列、Sysmex XE-2100），对FRC/裂细胞的自动计数和显微镜计数进行了比较研究。
ADVIA的FRC参考范围<0.3%，XE-2100的参考范围<0.5%。FRC低于确定为1%的阈值（ADVIA和XE-2100）时，排除血液涂片上裂细胞存在的阴性预测值接近100%，但预测值较差。
我们的研究验证了ABCC上即时可用的FRC参数在排除裂细胞和诊断TMA方面的效用。
