Yonsei Med J.  2011 Sep;52(5):845-850. 10.3349/ymj.2011.52.5.845.

Rapid Identification of Thrombocytopenia-Associated Multiple Organ Failure Using Red Blood Cell Parameters and a Volume/Hemoglobin Concentration Cytogram

• Yoo JH
• Lee J
• Roh KH
• Kim HO
• Song JW
• Choi JR
• Kim YK
• Lee KA

• KMID: 1108079
• DOI: http://doi.org/10.3349/ymj.2011.52.5.845

Abstract

Thrombocytopenia-associated multiple organ failure (TAMOF) has a high mortality rate when not treated, and early detection of TAMOF is very important diagnostically and therapeutically. We describe herein our experience of early detection of TAMOF, using an automated hematology analyzer. From 498,390 inpatients, we selected 12 patients suspected of having peripheral schistocytosis, based on the results of red blood cell (RBC) parameters and a volume/hemoglobin concentration (V/HC) cytogram. We promptly evaluated whether the individual patients had clinical manifestations and laboratory findings were consistent with TAMOF. Plasma exchanges were then performed for each patient. All 12 patients had TAMOF. The mean values of RBC parameters were significantly higher in all of the patients than with the reference range, however, 3 patients had % RBC fragments within the reference range. The mean value of ADAMTS-13 activity was slightly lower in patients compared with the reference range. Of the 12 patients, remission was obtained in 9 patients (75%) within 4 to 5 weeks using plasma exchanges. Three patients died. An increased percentage of microcytic hyperchromic cells with anisocytosis and anisochromia indicated the presence of schistocytes, making it an excellent screening marker for TAMOF. Identification of TAMOF with RBC parameters and a V/HC cytogram is a facile and rapid method along with an automated hematology analyzer already in use for routine complete blood cell counting test.

Keyword

Thrombocytopenia-associated multiple organ failure; hematology analyzer; RBC parameter; volume/hemoglobin concentration cytogram

MeSH Terms

Adult
Aged
Aged, 80 and over
Erythrocyte Indices
Erythrocytes, Abnormal/pathology
Female
Hematologic Tests
Hemoglobins/metabolism
Humans
Male
Middle Aged
Multiple Organ Failure/*blood/*diagnosis/etiology
Thrombocytopenia/*blood/complications/*diagnosis

Figure

• 

  Fig. 1 A red blood cell (RBC) volume/hemoglobin concentration (V/HC) cytogram. (A) Normal RBC V/HC cytogram. Hemoglobin concentration is plotted along the x-axis, and the mean corpuscular volume (MCV) of the RBCs is plotted along the y-axis. (B) The RBC V/HC cytogram of a representative patient with TAMOF (case 6). Percent micro indicates the percent of RBCs smaller than 60 fL and % hyper indicates the percent of RBCs with more than 41 g/dL of hemoglobin. HGB, hemoglobin.

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