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Jean Francois Lesesve - One of the best experts on this subject based on the ideXlab platform.
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Erythrocytes morphology in pregnancy.
Annales de biologie clinique, 2019Co-Authors: Jean Francois Lesesve, Claire Franczak, Julien PerrinAbstract:Morphologic anomalies of the red blood cells (RBCs) during pregnancy are poorly known. Peripheral blood films from 69 healthy pregnant women were investigated for shape, color and content anomalies of the RBCs. A range of minor alterations was observed, without clinical significance. Only a slight increase of polychromatophilic RBCs was regularly observed. However, we would like to stress that spherocytes or Schistocytes can occasionally be found, even in the absence of hemolysis.
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Rôle du biologiste confronté à une recherche de schizocytes Schistocytes measurement in the laboratory of haematology
2016Co-Authors: Jean Francois Lesesve, Sylvain Salignac, Pierre Bordigoni, Thomas Lecompte, Xavier TroussardAbstract:The Schistocytes are fragmented red blood cells mainly observed in the setting of haemolytic anaemias and particularly among the thrombotic microangio- pathies. The presence of Schistocytes is an important criterion for the diagnosis mechanical anaemias, though the identification of these cells remains problematic. As we observed a high variability of the morphologic identification criterias of the Schistocytes among morphologists, we proposed some guidelines in a text of recommendations (Delphi method, participation of approximately 100 biologists, 2003). A Schistocyte was defined as a red blood cell of decreased size, with a linear segment corresponding to the zone of fragmentation and the presence of angles (helmet, crescent, triangle shapes). The recognition of the Schistocytes being observer-dependent, a computorised morphometric analysis of digitalized images should help, but does not exist yet! In a more practical way, we evaluated the contribution of the parameter fragmented red cell (FRC) available on some automated blood cells analyzers. A partial correlation between Schistocytes observed on smear and automated counted FRC was found. The negative predic- tive value of the FRC was good to exclude the diagnosis of thrombotic microangio- pathy. In conclusion, the morphologist should be aware of the difficulties of the research of the Schistocytes on a blood smear and keep themselves up to date with the technological possibilities recently developed by the blood cells counters.
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Schistocytes.
Transfusion, 2014Co-Authors: Jean Francois Lesesve, Odile Fenneteau, Gina ZiniAbstract:..
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Schistocytes in disseminated intravascular coagulation.
International journal of laboratory hematology, 2013Co-Authors: Jean Francois Lesesve, M. Martin, C. Banasiak, E. André-kerneïs, Valérie Bardet, Daniel Lusina, A. Kharbach, Franck Geneviève, Thomas LecompteAbstract:Summary Introduction The presence of Schistocytes on the peripheral blood film during disseminated intravascular coagulation (DIC) remains controversial. Methods We examined Schistocytes count on blood films from 35 DIC patients and checked morphological anomalies of all RBCs. Results Thirty of 35 patients presented with Schistocytes and 22 with acanthocytes, which was the commonest shape anomaly. Mean percentage ± standard deviation was 0.33 ± 0.38%, median value was 0.1%, and range was 0–1.4%. The patients with Schistocytes ≥ 1% had circumstances frequently associated with increased Schistocytes count (promyelocytic leukaemia, pregnancy, severe infection). Discussion Schistocytes were thus frequently observed in DIC patients, usually with low percentage, within or close to the reference range (
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fragmented red blood cells automated measurement is a useful parameter to exclude Schistocytes on the blood film
International Journal of Laboratory Hematology, 2012Co-Authors: Jean Francois Lesesve, Vahid Asnafi, F. Braun, Gina ZiniAbstract:Summary Introduction: The diagnosis of thrombotic microangiopathies (TMA) or disorders that may mimic their features remains difficult. Mechanical hemolytic anemia with the detection of shistocytes on the blood smear is a cornerstone finding to assess the diagnosis, but microscopic evaluation of shistocytes is still problematic with wide interobserver variations. Some of the latest generation automated blood cell counters (ABCC) propose an original quantitative approach of fragmented red cells (FRC), aiming to be equivalent to the microscopic count. This parameter has been poorly evaluated. Methods: To assess the predictive value (PV) of this test, we conducted studies comparing automated and microscopic counts of FRC/Schistocytes, based on the analysis of thousands samples in four university hospitals and using the 2 ABCC currently available (Siemens ADVIA series, Sysmex XE-2100). Results: Reference range for FRC was <0.3% for the ADVIA and <0.5% for the XE-2100. The presence of FRC below a threshold determined at 1% (ADVIA and XE-2100) had a negative PV close to 100% to exclude the presence of Schistocyte on the blood smear, but in relationship with a poor PV value. Conclusions: Our study validated the utility of the immediately available FRC parameter on ABCC to exclude Schistocytes and the diagnosis of TMA.
Alberto Moggi Pignone - One of the best experts on this subject based on the ideXlab platform.
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The doctor who stared at Schistocytes: an intriguing case of suspected thrombotic microangiopathic anemia
Internal and Emergency Medicine, 2019Co-Authors: Filippo Pieralli, Alessandro Milia, Silvia Fruttuoso, Giulia Bandini, Paolo Mercatelli, Chiara Nozzoli, Fabio Luise, Antonio Mancini, Lucia Sammicheli, Alberto Moggi PignoneAbstract:A 33-year-old man with type 1 diabetes mellitus was admitted to the Internal Medicine Unit due to subacute onset of exertional dyspnea, with evidence at initial blood exams of severe macrocytic anemia with thrombocytopenia, biohumoral signs of hemolysis and 5 Schistocytes per magnified field on the blood smear. A thrombotic microangiopathy (TMA) was suspected and plasma exchange (PEX) was started soon, since the risk of a life threatening condition. On the second day, after the results of A Disintegrin And Metalloproteinase with ThromboSpondin-1 motif, member 13 (ADAMTS-13) and reticulocytes were available, a critical reappraisal of the clinical scenario was done. B12 vitamin deficiency was evident after completing the diagnostic work-up. Finally, a diagnosis of “pseudo TMA vitamin B12 deficiency-related” was done. This is an intriguing and rare manifestation of cobalamin deficiency, given the very uncommon occurrence of Schistocytes in this condition. “Pseudo TMA vitamin B12 deficiency-related” should be kept in mind when facing the differential diagnosis of microangiopathic anemia in the presence of a low proliferative index.
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The doctor who stared at Schistocytes: an intriguing case of suspected thrombotic microangiopathic anemia
Internal and Emergency Medicine, 2019Co-Authors: Filippo Pieralli, Alessandro Milia, Silvia Fruttuoso, Giulia Bandini, Paolo Mercatelli, Chiara Nozzoli, Fabio Luise, Antonio Mancini, Lucia Sammicheli, Alberto Moggi PignoneAbstract:A 33-year-old man with type 1 diabetes mellitus was admitted to the Internal Medicine Unit due to subacute onset of exertional dyspnea, with evidence at initial blood exams of severe macrocytic anemia with thrombocytopenia, biohumoral signs of hemolysis and 5 Schistocytes per magnified field on the blood smear. A thrombotic microangiopathy (TMA) was suspected and plasma exchange (PEX) was started soon, since the risk of a life threatening condition. On the second day, after the results of A Disintegrin And Metalloproteinase with ThromboSpondin-1 motif, member 13 (ADAMTS-13) and reticulocytes were available, a critical reappraisal of the clinical scenario was done. B12 vitamin deficiency was evident after completing the diagnostic work-up. Finally, a diagnosis of “pseudo TMA vitamin B12 deficiency-related” was done. This is an intriguing and rare manifestation of cobalamin deficiency, given the very uncommon occurrence of Schistocytes in this condition. “Pseudo TMA vitamin B12 deficiency-related” should be kept in mind when facing the differential diagnosis of microangiopathic anemia in the presence of a low proliferative index.
Thomas Lecompte - One of the best experts on this subject based on the ideXlab platform.
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Rôle du biologiste confronté à une recherche de schizocytes Schistocytes measurement in the laboratory of haematology
2016Co-Authors: Jean Francois Lesesve, Sylvain Salignac, Pierre Bordigoni, Thomas Lecompte, Xavier TroussardAbstract:The Schistocytes are fragmented red blood cells mainly observed in the setting of haemolytic anaemias and particularly among the thrombotic microangio- pathies. The presence of Schistocytes is an important criterion for the diagnosis mechanical anaemias, though the identification of these cells remains problematic. As we observed a high variability of the morphologic identification criterias of the Schistocytes among morphologists, we proposed some guidelines in a text of recommendations (Delphi method, participation of approximately 100 biologists, 2003). A Schistocyte was defined as a red blood cell of decreased size, with a linear segment corresponding to the zone of fragmentation and the presence of angles (helmet, crescent, triangle shapes). The recognition of the Schistocytes being observer-dependent, a computorised morphometric analysis of digitalized images should help, but does not exist yet! In a more practical way, we evaluated the contribution of the parameter fragmented red cell (FRC) available on some automated blood cells analyzers. A partial correlation between Schistocytes observed on smear and automated counted FRC was found. The negative predic- tive value of the FRC was good to exclude the diagnosis of thrombotic microangio- pathy. In conclusion, the morphologist should be aware of the difficulties of the research of the Schistocytes on a blood smear and keep themselves up to date with the technological possibilities recently developed by the blood cells counters.
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Schistocytes in disseminated intravascular coagulation.
International journal of laboratory hematology, 2013Co-Authors: Jean Francois Lesesve, M. Martin, C. Banasiak, E. André-kerneïs, Valérie Bardet, Daniel Lusina, A. Kharbach, Franck Geneviève, Thomas LecompteAbstract:Summary Introduction The presence of Schistocytes on the peripheral blood film during disseminated intravascular coagulation (DIC) remains controversial. Methods We examined Schistocytes count on blood films from 35 DIC patients and checked morphological anomalies of all RBCs. Results Thirty of 35 patients presented with Schistocytes and 22 with acanthocytes, which was the commonest shape anomaly. Mean percentage ± standard deviation was 0.33 ± 0.38%, median value was 0.1%, and range was 0–1.4%. The patients with Schistocytes ≥ 1% had circumstances frequently associated with increased Schistocytes count (promyelocytic leukaemia, pregnancy, severe infection). Discussion Schistocytes were thus frequently observed in DIC patients, usually with low percentage, within or close to the reference range (
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Evaluation of Schistocyte monitoring after haematopoietic stem cell transplantation
International journal of laboratory hematology, 2011Co-Authors: Jean Francois Lesesve, Sylvain Salignac, François Alla, Thomas Lecompte, F. Dugué, L. Clément, Pierre BordigoniAbstract:Summary Introduction: Observation of Schistocytes on the peripheral blood following haematopoietic stem cell transplantation (SCT) is a common finding. As their presence is not specific to the onset of SCT-related thrombotic microangiopathy, we evaluated the interest of Schistocyte measurement twice a week during the entire follow-up of 195 patients undergoing SCT, particularly focussing on the 125 allogeneic SCT. Methods: Schistocytes were strickly defined as triangular-, crescent- or helmet-shaped red blood cells according to consensus standards and were checked blindly under the microscope and with computer image analysis. Results: Mean Schistocyte percentage was 0.7% (±0.5%, reference value ≤0.5). High Schistocyte percentage was observed after allografts (0.79%) when compared to autologous SCT (0.47, P 1.2%. SCT-TM grade ≥2 occurred in nine patients. A marked rise in Schistocyte >4.5% was observed, which was not reached during the other SCT-related complications. Children with ALL, undergoing unrelated allogeneic SCT, with early acute graft-versus-host disease refractory to steroids were prone to present SCT-TM, associated with VOD, interstitial pneumopathy and HC, resulting in a high mortality rate (six of seven patients). Our data confirmed that schistocytosis was common after SCT. Mild percentages were likely concomitant with extensive endothelial damage but higher percentage should have prompted to a close monitoring with SCT-TM investigation. Conclusion: In our experience, systematic Schistocyte count after HSCT proved to be useful: the occurrence of an increased percentage was a surrogate marker for complications even if unspecific for TM.
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Comparative evaluation of Schistocyte counting by an automated method and by microscopic determination.
American journal of clinical pathology, 2004Co-Authors: Jean Francois Lesesve, Sylvain Salignac, François Alla, Michael Defente, Mohamed Benbih, Pierre Bordigoni, Thomas LecompteAbstract:Schistocytes are circulating RBC fragments. The morphologic identification of Schistocytes is difficult because the shapes to which they correspond are still under discussion. Automated hematology systems permit the possibility of direct measurement of RBC fragments. We compared Schistocyte counts performed by different biologists and technicians with the automated counts by the ADVIA 120 (Bayer Health Care, Tarrytown, NY). The agreement between the ADVIA 120 and the average of the observers gives a correlation coefficient of 0.7274 (95% confidence interval, 0.6285-0.8019). The ADVIA 120 has a tendency to overestimate the count (average, +0.445%). No false-negative case was recorded. The maximum sensitivity (detection of 100% of samples with Schistocytes) of the analyzer was determined at a threshold value of 0.25%, but the specificity was low (20%). Therefore, a blood smear examination remains necessary to confirm Schistocyte presence. However, the clinical features correlated particularly with negative automated RBC fragments, and the high negative predictive value of RBC fragments ruled out thrombotic events (macroangiopathies or microangiopathies).
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Role of the biologist in the study of Schistocytes
Annales de biologie clinique, 2003Co-Authors: Jean Francois Lesesve, Thomas Lecompte, Odile Fenneteau, T. Cynober, M J Grange, G. Flandrin, Xavier TroussardAbstract:The appearance of Schistocytes in a peripheral blood film is considered to be an important diagnostic marker for thrombotic microangiopathy. However, the morphological analysis of Schistocytes remains uneasy. To determine practice patterns in the biological management of schistocytosis, the French Group of Cellular Hematology from the French Society of Hematology conducted a survey on the approach of the diagnosis of microangiopathy. A guideline is proposed in order to cancel the substantial variation among biologists.
Sterling T. Bennett - One of the best experts on this subject based on the ideXlab platform.
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Neonates with suspected microangiopathic disorders: performance of standard manual Schistocyte enumeration vs. the automated fragmented red cell count
Journal of Perinatology, 2019Co-Authors: Timothy M. Bahr, Allison J. Judkins, Robert D. Christensen, Erick Henry, Vickie L. Baer, Stephen D. Minton, Erick Gerday, Sterling T. BennettAbstract:Objectives To enhance the diagnosis of Schistocyte-producing conditions, we compared routine manual Schistocyte enumeration with automated fragmented red cell counts (FRCs). Study design In neonates “suspected” of having sepsis, NEC, or DIC we compared manual Schistocyte estimates vs. automated FRC counts. When the two disagreed , we used a “gold standard” from a ≥ 1000 RBC differential. We also assessed the diagnostic accuracy of the FRC count in diagnosing sepsis, NEC, or DIC. Results We collected 270 CBCs from 90 neonates. The methods agreed in 63% (95% CI 55%–70%) of the CBCs. Among the 37% where they disagreed, the FRC count was more accurate in 100% (95% CI 88–100%). An elevated FRC count was specific for sepsis, and was sensitive and specific for necrotizing enterocolitis and DIC. Conclusions Automated FRC counts have advantages over routine manual evaluation, larger sample size, lower expense, and superior accuracy in diagnosing Schistocyte-producing conditions.
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Automated Quantification of Fragmented Red Blood Cells: Neonatal Reference Intervals and Clinical Disorders of Neonatal Intensive Care Unit Patients with High Values.
Neonatology, 2018Co-Authors: Allison J. Judkins, Brianna C. Macqueen, Robert D. Christensen, Erick Henry, Gregory L. Snow, Sterling T. BennettAbstract:BACKGROUND Schistocytes are circulating erythrocyte fragments. They can be identified microscopically from a blood smear; but automated systems evaluate more cells and avoid inconsistencies in microscopy. Studies using adult subjects indicate that automated quantification of Schistocytes can be clinically useful. However, reference intervals for automated Schistocyte counts of neonates have not been published, and the relevance of a high automated Schistocyte count from neonates has not been reported. OBJECTIVES Using retrospective automated neonatal complete blood count (CBC) data, we created reference intervals for fragmented red cells (FRCs) and sought to discover the clinical conditions of neonates with high FRCs (above the upper reference interval). RESULTS We created reference intervals based on 39,949 CBCs from 15,655 neonates 0-90 days old. The lower reference interval was 0 FRC/µL and the upper interval was 100,000/µL. The highest FRCs (96 CBCs from 44 neonates) were > 250,000/µL. These neonates clustered into the following groups: 37% had sepsis, 29% had disseminated intravascular coagulation (DIC), 17% had a genetic syndrome, 14% necrotizing enterocolitis (NEC), and 7% had iron deficiency (some had more than one diagnosis). Based on the reference intervals, we divided the 39,949 FRC values into 3 groups: (1) 200,000/µL ("extremely elevated"). The odds that a microangiopathic condition (DIC, sepsis, NEC) or a microcytic disorder (iron deficiency) were present were significantly higher in the moderately elevated, and more so in the extremely elevated group. CONCLUSIONS Our study suggests that a high FRC could prompt investigation into, or inform follow-up of, a neonatal microangiopathic or extremely microcytic disorder.
Filippo Pieralli - One of the best experts on this subject based on the ideXlab platform.
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The doctor who stared at Schistocytes: an intriguing case of suspected thrombotic microangiopathic anemia
Internal and Emergency Medicine, 2019Co-Authors: Filippo Pieralli, Alessandro Milia, Silvia Fruttuoso, Giulia Bandini, Paolo Mercatelli, Chiara Nozzoli, Fabio Luise, Antonio Mancini, Lucia Sammicheli, Alberto Moggi PignoneAbstract:A 33-year-old man with type 1 diabetes mellitus was admitted to the Internal Medicine Unit due to subacute onset of exertional dyspnea, with evidence at initial blood exams of severe macrocytic anemia with thrombocytopenia, biohumoral signs of hemolysis and 5 Schistocytes per magnified field on the blood smear. A thrombotic microangiopathy (TMA) was suspected and plasma exchange (PEX) was started soon, since the risk of a life threatening condition. On the second day, after the results of A Disintegrin And Metalloproteinase with ThromboSpondin-1 motif, member 13 (ADAMTS-13) and reticulocytes were available, a critical reappraisal of the clinical scenario was done. B12 vitamin deficiency was evident after completing the diagnostic work-up. Finally, a diagnosis of “pseudo TMA vitamin B12 deficiency-related” was done. This is an intriguing and rare manifestation of cobalamin deficiency, given the very uncommon occurrence of Schistocytes in this condition. “Pseudo TMA vitamin B12 deficiency-related” should be kept in mind when facing the differential diagnosis of microangiopathic anemia in the presence of a low proliferative index.
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The doctor who stared at Schistocytes: an intriguing case of suspected thrombotic microangiopathic anemia
Internal and Emergency Medicine, 2019Co-Authors: Filippo Pieralli, Alessandro Milia, Silvia Fruttuoso, Giulia Bandini, Paolo Mercatelli, Chiara Nozzoli, Fabio Luise, Antonio Mancini, Lucia Sammicheli, Alberto Moggi PignoneAbstract:A 33-year-old man with type 1 diabetes mellitus was admitted to the Internal Medicine Unit due to subacute onset of exertional dyspnea, with evidence at initial blood exams of severe macrocytic anemia with thrombocytopenia, biohumoral signs of hemolysis and 5 Schistocytes per magnified field on the blood smear. A thrombotic microangiopathy (TMA) was suspected and plasma exchange (PEX) was started soon, since the risk of a life threatening condition. On the second day, after the results of A Disintegrin And Metalloproteinase with ThromboSpondin-1 motif, member 13 (ADAMTS-13) and reticulocytes were available, a critical reappraisal of the clinical scenario was done. B12 vitamin deficiency was evident after completing the diagnostic work-up. Finally, a diagnosis of “pseudo TMA vitamin B12 deficiency-related” was done. This is an intriguing and rare manifestation of cobalamin deficiency, given the very uncommon occurrence of Schistocytes in this condition. “Pseudo TMA vitamin B12 deficiency-related” should be kept in mind when facing the differential diagnosis of microangiopathic anemia in the presence of a low proliferative index.
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The ability of clinical and laboratory findings to predict in-hospital death in patients with thrombotic thrombocytopenic purpura in an internal and emergency medicine department
PAGEPress Publications, 2012Co-Authors: Filippo Pieralli, Antonio Mancini, Alberto Camaiti, Giancarlo Berni, Carlo NozzoliAbstract:Introduction: Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening syndrome characterized by microangiopathic anemia, thrombocytopenia, diffuse microvascular thrombosis, and ischemia. It is associated with very low levels of ADAMTS-13. Measurement of ADAMTS-13 levels is used for diagnostic and prognostic purposes, but in every-day clinical practice, this type of analysis is not always readily available. In this retrospective study, we evaluated prognostic value of clinical and laboratory findings in patients with TTP. Materials and methods: We retrospectively investigated patients with clinically diagnosed TTP treated in a unit of Internal and Emergency Medicine (1996-2007). Clinical and laboratory findings were collected and analyzed in order to assess their ability to predict in-hospital death. Results: Twelve patients were identified (mean age 59 + 22 years; 58% were women). Five (42%) died during the hospitalization, and the variables significantly associated with this outcome were: a delay between diagnosis and symptom onset (HR 1.36; 95% CI 1.04-1.78; p < 0.05); a higher severity score (HR 1.48; 95%CI 1,23-3.86; p < 0.05); hemodynamic instability with hypotension and/or shock (HR 3.35; 95%CI 3.02-9.26; p < 0.01); a higher Schistocyte count on blood smear (HR 1.84; 95%CI 1.04-3.27; p < 0.05); and higher lactate values (HR 1.85; 95%CI 1.08- 3.16; p < 0.05). Conclusions: TTP is a rare and potentially fatal disease with protean manifestations. Delayed diagnosis after symptom onset is a major determinant of poor outcome. Hypotension and shock are also prognostically unfavourable. Laboratory evidence of cardiocirculatory compromise (i.e., elevated lactate levels) and extension of the disease process (i.e., Schistocyte count > 3) are predictive of in-hospital death, independently of the hemodynamic profile on admission
