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.
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.
TTP was diagnosed in this patient owing to the presence of thrombocytopenia, MAHA with schistocytes
of 3% and neurological manifestations.!91 Systemic bacterial and fungal infections were excluded with several negative blood cultures, as severe sepsis is one of the differentials for schistocytosis and thrombocytopenia.
Important distinguishing features that may assist in diagnosing TTP in this context include the presence of schistocytes
on peripheral smear, a negative Coombs test, normal complement levels, and a low level of ADAMTS13 activity.
Microangiopathic hemolysis ([greater than or equal to]1% schistocytes
plus helmet cells and the presence of any number of spherocytes)
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.
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.
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.