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Peripheral blood smear in patient with thrombotic thrombocytopenic purpura. Typical schistocytes are annotated. A schistocyte or schizocyte (from Greek schistos for "divided" and kytos for "hollow" or "cell") is a fragmented part of a red blood cell. Schistocytes are typically irregularly shaped, jagged, and have two pointed ends. [1]
Microangiopathic hemolytic anemia may be suspected based on routine medical laboratory tests such as a CBC (complete blood cell count). Automated analysers (the machines that perform routine full blood counts in most hospitals) are designed to flag blood specimens that contain abnormal amounts of red blood cell fragments or schistocytes. [2]
In some cases, a peripheral blood smear may show schistocytes, anisocytosis, polychromasia, or poikilocytosis. [7] Direct antiglobulin testing is the only way to confirm DIIHA. Direct antiglobulin testing can determine if complement C3 antibody and/or immunoglobulin G is bound to the red blood cell membrane. [4]
Direct examination of blood under a microscope in a peripheral blood smear may demonstrate red blood cell fragments called schistocytes, red blood cells that look like spheres (spherocytes), and/or red blood cells missing small pieces .
Howell–Jolly bodies: small, round inclusions seen in erythrocytes (peripheral blood – MGG stain) This DNA appears as a basophilic (purple) spot on the otherwise eosinophilic (pink) erythrocyte on a standard H&E stained blood smear.
Acanthocytes, from peripheral blood, under light microscopy. Note the irregularly shaped, non-circular cells in the image. Acanthocyte (from the Greek word ἄκανθα acantha, meaning 'thorn'), in biology and medicine, refers to an abnormal form of red blood cell that has a spiked cell membrane, due to thorny projections.
The peripheral blood smear may show fragmented red blood cells (known as schistocytes) due to shear stress from thrombi. However, this finding is neither sensitive nor specific for DIC; A diagnostic algorithm has been proposed by the International Society of Thrombosis and Haemostasis.
Modern complete blood count analyzers can provide an automated white blood cell differential, but they have a limited ability to differentiate immature and abnormal cells, so manual examination of the blood smear is frequently indicated. [5] [6] Blood smear examination is the preferred diagnostic method for certain parasitic infections, such as ...