Six of 8 histologic features, including endothelial cell separation, intraluminal schistocytes
, intraluminal fibrin, intraluminal microthrombi, loss of glands, and mucosal denudation, were statistically increased in patients who met all the parameters for hrTA-TMA.
Peripheral blood smears were routinely prepared from all TTP patients and frequency of the schistocyte
on the blood film was estimated as mild, moderate and severe at 1000X magnification.
TTP was diagnosed in this patient owing to the presence of thrombocytopenia, MAHA with schistocytes
of 3% and neurological manifestations.
Peripheral smear showed fragmented RBCs like schistocytes
The diagnosis of TTP was made when patients exhibited the following: 1) thrombocytopenia; 2) evidence of Coombs-negative hemolysis as manifested by an elevated serum LDH, low serum haptoglobin, and elevated indirect bilirubin; 3) microangiopathic red cell changes as manifested by > 3 schistocytes
or helmet cells per high power field on blood smear; 4) the absence of other etiologies of thrombocytopenia such as heparin (negative heparin-PF4 antibody), disseminated intravascular coagulation (DIC), drugs, sepsis, or post transfusion purpura.
A peripheral blood smear showed decreased normocytic red blood cells and scattered schistocytes
sup] However, MAHA in TTP and SLE may be distinguished by the presence of schistocytes
, which are mainly caused by mechanical trauma in the microvasculature.
Hemolytic uremic syndrome (HUS) is defined by a triad of microangiopathic hemolytic anemia (characterized by schistocytes
and helmet cells, as shown in Fig.
The diagnosis of thrombotic thrombocytopenic purpura was confirmed after exclusion of many of the aetiological factors of postoperative digital ischaemia, a positive haemolytic screen and blood film examination which showed schistocytes
and fragmented red cells.
4 BUN (mg/dL) 28 8-84 LDH (units/L) 1,080 131-3,007 ADAMTS13 activity level (%) 90 * 84-131 Schistocytes
present 8 -- (no.
Blood smear examination demonstrated red blood cell fragmentation, a few schistocytes
The clinical presentation of all of our cases were consistent with TTP (thrombocytopenia, microangiopathic hemolysis with schistocytes
in the peripheral blood smear, elevated LDH) and supported by severe ADAMTS-13 deficiency (< 5%).
Peripheral smear revealed basophilic stippling, nucleated red blood cells, and absence of schistocytes
Blood peripheral smear from the day of admission was significant for the schistocytes
(Figure 1) suggesting ongoing haemolysis.
Although no schistocytes
were evident on peripheral blood smear, the internist was concerned and consulted a nephrologist at a nearby regional hospital.