Department of Laboratory Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.
Int J Lab Hematol. 2013 Oct;35(5):542-7. doi: 10.1111/ijlh.12059. Epub 2013 Mar 9.
Recently, a consensus report for microscopic schistocyte determination was prepared by International Council for Standardization in Hematology (ICSH). ICSH focused on diagnosis of thrombocytopenic purpura (TTP)/hemolytic uremic syndrome (HUS). We aimed to reanalyze schistocytes according to ICSH recommendations, to study diseases other than TTP/HUS related to the schistocytes, and to compare the percentage of schistocytes among the various diseases.
We retrieved all reported cases of peripheral blood (PB) smear in a single institution during 6 years. Schistocytes on 282 PB smears showing previous peripheral schistocytes and hemoglobin ≤10 g/dL were recounted according to ICSH recommendations.
The schistocytes were frequently observed in patients with microangiopathic hemolytic anemia (MAHA), metastatic carcinoma, sepsis, chronic renal failure, preterm infant, and infection. Only two among 34 patients categorized as MAHA were diagnosed as TTP/HUS. Schistocytes were observed with other morphological changes in 169 of 170 cases with schistocyte ≤1% and in 102 of 112 with schistocyte >1%. The median schistocyte percentages of patients with hematologic malignancy, megaloblastic anemia, acute renal failure, and preterm infant were 1.20%, 1.30%, 1.35%, and 1.70%, respectively.
Schistocytes were observed above 1% in many diseases other than TTP /HUS. Therefore, it is important to understand that schistocytes could be seen in various diseases, and in these cases, schistocytes were usually detected together with other red blood cell morphologic changes. These data support ICSH recommendation that a schistocyte count should be considered clinically meaningful if schistocytes represent the main morphological abnormality in the PB smear.
最近，国际血液学标准化委员会（ICSH）制定了一份关于显微镜下裂体细胞检测的共识报告。该报告重点关注血小板减少性紫癜（TTP）/溶血尿毒综合征（HUS）的诊断。我们旨在根据 ICSH 建议重新分析裂体细胞，研究与裂体细胞相关的除 TTP/HUS 以外的其他疾病，并比较各种疾病之间裂体细胞的百分比。
我们在一家机构的 6 年期间检索了所有报道的外周血（PB）涂片病例。根据 ICSH 建议，对 282 份显示先前外周裂体细胞和血红蛋白≤10g/dL 的 PB 涂片上的裂体细胞进行重新计数。
微血管性溶血性贫血（MAHA）、转移性癌、脓毒症、慢性肾衰竭、早产儿和感染患者中经常观察到裂体细胞。在归类为 MAHA 的 34 例患者中，仅有 2 例被诊断为 TTP/HUS。在 170 例裂体细胞≤1%的病例和 112 例裂体细胞>1%的病例中，均观察到裂体细胞伴有其他形态改变。血液恶性肿瘤、巨幼细胞性贫血、急性肾衰竭和早产儿患者的裂体细胞百分比中位数分别为 1.20%、1.30%、1.35%和 1.70%。
除 TTP/HUS 以外的许多疾病中，裂体细胞>1%。因此，了解裂体细胞也可能在其他疾病中出现是很重要的，在这些情况下，裂体细胞通常与其他红细胞形态变化一起被检测到。这些数据支持 ICSH 的建议，即如果裂体细胞代表 PB 涂片的主要形态异常，则裂体细胞计数应被视为具有临床意义。
