Fragmented Red Cell as a Possible Favorable Prognostic Marker of Hematopoietic Stem Cell Transplantation Associated Thrombotic Microangiopathy.
BACKGROUND
Fragmented red cell (FRC) by automated hematologic analyzer is known to detect schistocyte. In this study, it is noted that FRC might be a favorable prognostic marker of hematopoietic stem cell transplantation associated thrombotic microangiopathy (TA-TMA).


METHODS
The peripheral blood samples and clinical data of 89 patients were collected. The diagnosis of TA-TMA was defined by the Blood and Marrow Transplant Clinical Trials Network's criteria and schistocyte or both schistocyte- and FRC-positive cases and other parameters fulfilled are regarded as TA-TMA.


RESULTS
Schistocyte and FRC displayed a correlation coefficient of 0.461 (P < 0.001) by Spearman's method. The diagnostic concordance of TA-TMA using schistocyte and FRC was 92.1% with kappa index of 0.531 (P < 0.001). The number of diagnosed patients and mean survival month were as follows: TA-TMA by schistocyte, 8 (8.9%), 13.5 month; TA-TMA by schistocyte and FRC, 7 (7.8%), 40.4 month; No TMA, 74 (83.1%), 38.3 month, respectively. Kaplan-Meier survival analysis by log-rank method of the patient with TA-TMA by schistocyte and rest of the group showed statistical significance (P < 0.01).


CONCLUSIONS
As evidenced by the data, FRC might be a favorable prognostic marker for TA-TMA, but additional studies with larger patients groups are required for validation of clinical applications.
Department of Laboratory Medicine, Incheon St. Mary's Hospital, Catholic University of Korea, Seoul, Korea.
Dong Wook
DW
Jekarl
Department of Laboratory Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea.
Yonggoo
Y
Kim
Department of Laboratory Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea.
Jihyang
J
Lim
Department of Laboratory Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea.
Myungshin
M
Kim
Department of Laboratory Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea.
Kyungja
K
Han
Division of Pediatric Hematology/Oncology, Department of Pediatrics, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea.
Bin
B
Cho
Division of Pediatric Hematology/Oncology, Department of Pediatrics, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea.
Hak-Ki
HK
Kim
Division of Hematology, Department of Internal Medicine, Catholic Hematopoietic Stem Cell Transplantation Center, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea.
Woo-Sung
WS
Min
Division of Hematology, Department of Internal Medicine, Catholic Hematopoietic Stem Cell Transplantation Center, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea.
Chang-Ki
CK
Min
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism*; D016022:Case-Control Studies; D004912:Erythrocytes / Q000378:metabolism* / Q000473:pathology; D005260:Female; D005434:Flow Cytometry; D005500:Follow-Up Studies; D006402:Hematologic Diseases / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate; D057049:Thrombotic Microangiopathies / Q000097:blood / Q000175:diagnosis* / Q000209:etiology
D015415:Biomarkers
fragmented red cell; schistocyte; transplantation-associated thrombotic microangiopathy