title: Rapid identification of thrombocytopenia-associated multiple organ failure using red blood cell parameters and a volume/hemoglobin concentration cytogram.
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.
authors.affiliation: Department of Laboratory Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea.
authors.forename: Jong-Ha
authors.initials: JH
authors.lastname: Yoo
authors.forename: Jongwook
authors.initials: J
authors.lastname: Lee
authors.forename: Kyoung Ho
authors.initials: KH
authors.lastname: Roh
authors.forename: Hyun Ok
authors.initials: HO
authors.lastname: Kim
authors.forename: Jae-Woo
authors.initials: JW
authors.lastname: Song
authors.forename: Jong-Rak
authors.initials: JR
authors.lastname: Choi
authors.forename: Young Keun
authors.initials: YK
authors.lastname: Kim
authors.forename: Kyung-A
authors.initials: KA
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004909:Erythrocyte Indices; D004913:Erythrocytes, Abnormal / Q000473:pathology; D005260:Female; D006403:Hematologic Tests; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology; D013921:Thrombocytopenia / Q000097:blood* / Q000150:complications / Q000175:diagnosis*
chemical_list: D006454:Hemoglobins