PubMed · 1560936
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L O Simpson. 1992-04-08. Red cell shape in multiple sclerosis.. https://pubmed.ncbi.nlm.nih.gov/1560936/
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Although the presence of acanthocytes (AC) is a reliable indicator of glomerular bleeding, acanthocytes could be observed in only 60% of patients with glomerulonephritis. Therefore, we attempted to develop a new method for diagnosing the origin of urinary bleeding by the morphological characteristics of doughnut-shaped of urinary red blood cells (RBC). In the present study, urine samples from 7 patients with glomerular bleeding and 4 patients with non-glomerular bleeding, and from 35 urine samples of the glomerular bleeding and non-glomerular bleeding-model were examined. The various type of RBC were observed by a phase contrast microscopic examination. The doughnut-shaped RBC were divided into three shapes (namely, smooth, uneven, target-shaped RBC) by individual characteristics. The appearance rate of each shape was calculated, and both outer and inner diameters of doughnut-shaped RBC in the photographs were also measured. Although there was no change in the value of outer diameter of doughnut-shaped RBC between glomerular bleeding and non-glomerular bleeding, the values of inner diameter of doughnut-shaped RBC in non-glomerular bleeding was significantly smaller than those in glomerular bleeding in all shapes. These results strongly suggested that the measurement of inner diameters of doughnut-shaped RBC is one of the useful diagnostic methods to distinguish the origin of urinary bleeding when AC could not be observed.
INTRODUCTION: Thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS) is characterized by thrombocytopenia, a microangiopathic hemolytic anemia (presence of schistocytes) and elevated LDH without another likely explanation. Standard of care is daily plasma exchange, which is typically discontinued when the platelet count exceeds 100-150 x 10(9)/L for 2 days. However, residual schistocytosis, the presence of schistocytes at the time of discontinuation of plasma exchange therapy, is often disconcerting. We evaluated the frequency and significance of residual schistocytosis in TTP/HUS patients when the patients' platelet counts returned to normal levels (e.g., 100-150 x 10(9)/L). METHODS: Retrospective review in our institution from 01/1999-03/2004 of all patients treated with plasma exchange for TTP/HUS with at least 2 months of follow-up for relapse was completed. Patients were excluded if the clinical course was complicated by HIV, stem cell/bone marrow and solid organ transplant, pregnancy and auto-immune disease. Schistocytes were documented on day of presentation and on the day the platelet count reached 150 x 10(9)/L. Grading scale (using 100 x objective-a high power field, with approximately 100 red blood cells per field) for schistocytes was as follows: rare for 1 schistocyte per every other other field, 1+ for 1-5%, 2+ for 6-15%, and 3+ for >15%. The frequency of schistocytes was compared to frequency of relapse within 2 months, using Fisher's exact test. RESULTS: We identified 57 patients with TTP/HUS who received plasma exchange therapy. Of these patients, 12 did not have a follow-up microscopic examination of a peripheral blood smear at discontinuation of plasma exchange therapy and were excluded from further analysis. Of the remaining 45 patients, 16 had residual schistocytosis (35.6%). There was no statistically significant difference in relapse rate with or without residual schistocytosis (P = 1.00, Fisher's Exact test, 2 sided). CONCLUSIONS: In this study, we found that the presence of residual schistocytosis is common (35.6%). The presence of residual schistocytosis, however, was not predictive of relapse.
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