In a prospective design, patients with symptoms suggestive of TMA, along with anemia and thrombocytopenia, were investigated and those confirmed by presence of significant number of schistocytes
on the peripheral blood smear were included in the study.
In peripheral smear, widespread schistocytes
, polychromasia, spherocytes, as well as high serum levels of indirect bilirubin and LDH were observed in our case.
So, for instance, a hemoglobin value of 9 g/dl in a 35-year old female with a thrombocyte count of 25 x [10.sup.9]/L in combination with a pre-classification result of 10 percent schistocytes
should be presented by the system as a high-priority differential.
Day 11 # Day 40 # Day 120 # C-reactive protein, mg/L 33.0 117.0 452.0 (N < 5.0) Plasma creatinine, mg/dL 1.21 2.73 5.5 (N: 0.60-1.30) Lactate dehydrogenase, IU/L 376 722 517 (N < 250) Hemoglobin, g/dL (N: 12.2-15.0) 9.6 7.7 7.0 Coombs test NA Negative Negative Platelets count, per [micro]/L 417,000 51,000 96,000 (N: 150000-450000) Haptoglobin, g/L (N: 0.3-2.0) NA <0.1 <0.1 Schistocytes
count, % of red NA 4 2 blood cells Tacrolimus trough level, ng/mL 9.0 26.5 9.9 Anti-HLA antibody screening * NA Negative Negative Complement C4, g/L (N: 0.1-0.4) NA 0.34 0.36 Complement C3, g/L (N: 0.9-1.8) NA 1.14 1.53 CMV (PCR), copies/mL Undetected Undetected Undetected # After kidney transplantation.
Normal coagulation profile, normal fibrinogen level, and absence of schistocytes
in the peripheral blood film were against DIC.
Haptoglobin was not decreased, and a peripheral smear examination was negative for schistocytes
, ruling out hemolytic uremic syndrome.
were observed on peripheral blood smear.
Indirect bilirubin and lactate dehydrogenase (LDH) were increased, serum haptoglobin was decreased, and a peripheral smear showed a few schistocytes
and some spherocytes; these findings were most consistent with autoimmune hemolytic anemia.
The 10 class labels chosen were based on clinical significance and availability: schistocytes
, dacrocytes (teardrop cells), acanthocytes, elliptocytes, stomatocytes, spherocytes, codocytes (target cells), echinocytes, overlap, and normal.
Our main hypothesis remained a thrombotic microangiopathy (TMA) despite the absence of schistocytes
on repeated blood tests.
The blood smear test showed schistocytes
and erythrocyte fragmentation, and ADAMTS13 test was negative.
Serum markers of TA-TMA include elevated lactate dehydrogenase, de novo thrombocytopenia not explained by other post-HSCT complications, Coombs test-negative hemolytic anemia (often hallmarked by increased free plasma hemoglobin and decreased haptoglobin), peripheral schistocytes
, and signs of renal dysfunction (proteinuria and elevated creatinine).
Hematological markers demonstrated HCT-TMA with thrombocytopenia, elevated lactate dehydrogenase, and schistocytes
The initial labs showed anaemia (Hb=7.1g/dl) and thrombocytopenia (plt=84*10^9/L) with 7% schistocytes
on peripheral smear.
Peripheral blood films in these cases revealed hypochromia and microcytosis, target cells and schistocytes
and pencil cells in those with iron deficiency complicating beta thalassemia trait.