range <18 [micro]mol/L 20-100 x [10.sup.9]/L Blood smear Moderate schistocytosis
and polychromasia Serology ANA ANCA Negative Negative Ref.
Patients presenting to the emergency department with the triad of hemolytic anemia, schistocytosis, and thrombocytopenia certainly merit screening for TTP, as this can be a lethal disease.
Following this study, a case of schistocytosis with [B.sub.12] deficiency was again initially treated with plasma exchange.
Two patients with TMA related to bevacizumab continued this therapy in association with antihypertensive drugs for 8 months despite persistent proteinuria and the occurrence of systemic manifestations (such as hemolysis, thrombocytopenia, and schistocytosis
) but renal function remained stable.
In actual practice however, the triad of thrombocytopenia, schistocytosis
and elevated lactate dehydrogenase levels is often sufficient to suggest the disorder (10,11).
(3) More recently, the clinical criteria for suspicion of TTP have been simplified to the triad of thrombocytopenia, schistocytosis and elevated LDH.
The triad of thrombocytopenia, hemolysis and schistocytosis may also be present in many other conditions.
Red blood cell morphology (anisocytosis and 1+ schistocytosis
) suggested mild hemolysis.
The hematological features of TTP, such as thrombocytopenia, hemolytic anemia, and schistocytosis
, suggest a wide differential diagnosis, including, but not limited to, disseminated intravascular coagulation, HUS, and autoimmune hemolysis.
In fact, multiple cases of pernicious anemia and the resulting Vitamin B12 deficiency presenting with MAHA and thrombocytopenia with schistocytosis
have been described [14-18].
Scharyj, "Marked elliptocytosis and schistocytosis
in hematopoietic dysplasia," American Journal of Clinical Pathology, vol.
Peripheral smear showed marked schistocytosis
(Figure 1) and dysplastic neutrophils (Figures 2(a) and 2(b)).