From the Guidelines
Schistocytes are associated with several serious medical conditions, primarily microangiopathic hemolytic anemias, including thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), disseminated intravascular coagulation (DIC), and malignant hypertension, as indicated in the most recent study 1. These conditions are characterized by the physical damage of red blood cells as they pass through abnormal small blood vessels. The presence of schistocytes in a blood smear is significant as it indicates ongoing red cell fragmentation and hemolysis, which can lead to anemia and other serious complications, such as those described in 1 and 1. Some of the key conditions associated with schistocytes include:
- Thrombotic thrombocytopenic purpura (TTP)
- Hemolytic uremic syndrome (HUS)
- Disseminated intravascular coagulation (DIC)
- Malignant hypertension
- Mechanical heart valve patients due to shear stress
- Severe burns
- Preeclampsia/HELLP syndrome in pregnant women
- Vasculitis
- Metastatic cancers that involve the microvasculature
- Certain chemotherapy treatments, as discussed in 1 and 1. The underlying mechanism involves red blood cells being torn apart as they navigate through fibrin strands in small blood vessels or encounter damaged vascular endothelium. It is essential to note that the presence of schistocytes is a critical diagnostic finding, and their management should be guided by the severity of the underlying condition, as outlined in the studies 1 and 1.
From the Research
Conditions Associated with Schistocytes
Schistocytes are associated with several conditions, including:
- Microangiopathic hemolytic anemia (MAHA) 2, 3, 4, 5
- Thrombotic thrombocytopenic purpura (TTP) 2, 3, 5, 6
- Hemolytic uremic syndrome (HUS) 2, 3, 5, 6
- Disseminated intravascular coagulation (DIC) 2, 3
- Pernicious anemia 2
- Metastatic carcinoma 3, 4, 5
- Sepsis 4
- Chronic renal failure 4
- Preterm infant 4
- Infection 4
- Malignancies, such as gastric, breast, prostate, lung, and lymphoma 3, 5
- Signet-ring cell carcinoma (SRCC) of the colon 3
- Cancer-induced or drug-induced thrombotic microangiopathy (TMA) 5
Characteristics of Schistocytes
Schistocytes are fragmented red blood cells due to the flow of blood through damaged capillaries and indicate endothelial injury 2. They are typically seen in conditions characterized by microvascular thrombosis, such as TTP and HUS 5. The presence of schistocytes can be an important diagnostic clue, but it is essential to consider the clinical context and other laboratory findings to determine the underlying cause 4, 6.