title: Usefulness of sequential automated analysis of fragmented red blood cells for the differential diagnosis of thrombotic thrombocytopenic purpura-hemolytic uremic syndrome following allogeneic hematopoietic cell transplantation.
abstract: Differentiating thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS) from other complications following allogeneic hematopoietic cell transplantation (HPCT) requires objective, reliable markers. To this purpose, we assessed the clinical usefulness of sequential quantified analysis of fragmented red blood cells (FRC) with the Sysmex XE-2100 automated hematology analyzer. The correlation between manual and automated counting was significant (r = 0.917; P < .0001). Of 25 cases, the peak FRC percentage (FRC%) exceeded 1.3% after allogeneic HPCT in 11 cases, and lactate dehydrogenase levels were elevated in 5 of these 11 cases. Two patients received diagnoses of TTP-HUS following allogeneic HPCT, and both had initial diagnoses of acute graft-versus-host disease. In both cases, the sharp increase in the FRC% to >3% simultaneously with clinical exacerbation was helpful for differentiating TTP-HUS following allogeneic HPCT from other complications. We conclude that FRC% data sequentially obtained by an automated count seem to be useful as an objective marker of TTP-HUS following allogeneic HPCT.
authors: Hyogo Red Cross Blood Center, 1-4-5 Wakinohamakaigan-dori, Chuo-ku, Kobe, Hyogo, Japan. imoto@hyogo.bc.jrc.or.jp
authors: Shion
authors: S
authors: Imoto
authors: Tohru
authors: T
authors: Murayama
authors: Kenichi
authors: K
authors: Nagai
authors: Norio
authors: N
authors: Hirabayashi
authors: Chiaki
authors: C
authors: Tanaka
authors: Mahito
authors: M
authors: Misawa
authors: Keiichiro
authors: K
authors: Kawasaki
authors: Ishikazu
authors: I
authors: Mizuno
authors: Tamio
authors: T
authors: Koizumi
authors: Kazuyoshi
authors: K
authors: Kajimoto
authors: Takayuki
authors: T
authors: Takahashi
authors: Hiroshi
authors: H
authors: Hara
authors: Shunichi
authors: S
authors: Kumagai
authors: Katsuyasu
authors: K
authors: Saigo
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001331:Automation; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004906:Erythrocyte Count / Q000295:instrumentation; D004912:Erythrocytes / Q000473:pathology*; D005260:Female; D006086:Graft vs Host Disease / Q000175:diagnosis; D006403:Hematologic Tests / Q000295:instrumentation*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006461:Hemolysis; D006463:Hemolytic-Uremic Syndrome / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011697:Purpura, Thrombotic Thrombocytopenic / Q000175:diagnosis* / Q000209:etiology; D014184:Transplantation, Homologous