Traversing Their Path to the Peripheral Smear: The Journey of Traumatized Red Blood Cells.

IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Journal of Laboratory Physicians Pub Date : 2023-09-01 DOI:10.1055/s-0043-1764481
Chethana Mannem, Tuba Saher, Gayathri Bilagali Ramdas
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Abstract

Background  Thrombotic microangiopathy encompasses a wide range of conditions, of which thrombotic thrombocytopenic purpura being a medical emergency requires prompt intervention, with schistocytes being a reliable morphological indicator of microvascular injury. However, there are conditions other than thrombotic microangiopathic anemia where schistocytes can be seen in large numbers. These nonthrombotic microangiopathic conditions are broadly grouped under cytoskeletal abnormalities, mechanical damage, and thermal injuries. Automated methods in schistocyte evaluation have shown varied reproducibility requiring manual identification. International Council for Standardization in Hematology (ICSH) recommends standardized morphological criteria and quantitative assessment as a percentage after counting at least 1,000 red blood cells in optimal areas of smear to reduce interobserver variability. Objectives  The aim of this study was to evaluate and quantitate schistocytes in thrombotic microangiopathic and nonthrombotic microangiopathic groups using ICSH guidelines and to evaluate interobserver reproducibility of manual schistocyte count. Materials and Methods  Overall, 157 peripheral blood smears showing schistocytes were studied by two independent observers using ICSH recommendations on light microscopy. The hematological findings were correlated with clinical diagnosis and other relevant investigations. Results  Schistocytes were observed in five cases of thrombotic microangiopathic anemia and 152 cases of nonthrombotic microangiopathic anemia. Schistocyte count in thrombotic microangiopathic anemia and nonthrombotic microangiopathic anemia groups with mean (±standard deviation) value was 2.28 ± 2.65% and 0.76 ± 0.67%, respectively ( p  < 0.001). The correlation coefficient between the two observers was 0.59 (confidence interval = 0.966-1.346) showing an excellent agreement on the reproducibility of schistocytes by application of ICSH guidelines. Conclusion  Percentage of schistocytes more than 1% is a robust morphological indicator for diagnosis of thrombotic microangiopathic anemia in adults. Strict application of ICSH guidelines reduces interobserver bias.

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穿越他们的路径到外周涂片:创伤红细胞的旅程。
血栓性微血管病包括多种情况,其中血栓性血小板减少性紫癜是一种医疗紧急情况,需要及时干预,而血吸虫细胞是微血管损伤的可靠形态学指标。然而,除了血栓性微血管病变性贫血外,在其他情况下也可以看到大量的血吸虫细胞。这些非血栓性微血管病变大致分为细胞骨骼异常、机械损伤和热损伤。在血吸虫细胞评估的自动化方法已经显示出不同的重复性需要人工鉴定。国际血液学标准化委员会(ICSH)推荐标准化形态学标准和在涂片最佳区域计数至少1000个红细胞后的百分比定量评估,以减少观察者之间的差异。本研究的目的是使用ICSH指南评估和定量血栓性微血管病变组和非血栓性微血管病变组的血吸虫细胞,并评估人工血吸虫细胞计数的观察者间可重复性。材料和方法总体而言,157个外周血涂片显示血吸虫细胞由两个独立的观察员使用ICSH推荐的光学显微镜研究。血液学检查结果与临床诊断和其他相关检查相关。结果5例血栓性微血管病变性贫血和152例非血栓性微血管病变性贫血中均可见到血吸虫细胞。血栓性微血管病变性贫血和非血栓性微血管病变性贫血组的血吸虫细胞计数平均值(±标准差)分别为2.28±2.65%和0.76±0.67% (p)结论血吸虫细胞百分比大于1%是诊断成人血栓性微血管病变性贫血的有力形态学指标。ICSH指南的严格应用减少了观察者之间的偏见。
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来源期刊
Journal of Laboratory Physicians
Journal of Laboratory Physicians MEDICINE, GENERAL & INTERNAL-
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审稿时长
31 weeks
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