Fragmented Red Cell as a Possible Favorable Prognostic Marker of Hematopoietic Stem Cell Transplantation Associated Thrombotic Microangiopathy

• Published in: Journal of clinical laboratory analysis Vol. 29; no. 6; pp. 444 - 450
• Main Authors: Jekarl, Dong Wook, Kim, Yonggoo, Lim, Jihyang, Kim, Myungshin, Han, Kyungja, Cho, Bin, Kim, Hak-Ki, Min, Woo-Sung, Min, Chang-Ki
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.11.2015; John Wiley & Sons, Inc; John Wiley and Sons Inc
• Subjects: Adult; Aged; Biomarkers - metabolism; Case-Control Studies; Erythrocytes - metabolism; Erythrocytes - pathology; Female; Flow Cytometry; Follow-Up Studies; fragmented red cell; Hematologic Diseases - therapy; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; Male; Middle Aged; Original; Prognosis; schistocyte; Stem cells; Survival analysis; Survival Rate; Thrombotic Microangiopathies - blood; Thrombotic Microangiopathies - diagnosis; Thrombotic Microangiopathies - etiology; transplantation-associated thrombotic microangiopathy; Transplants & implants; schistocyte; transplantation-associated thrombotic microangiopathy; fragmented red cell
• ISSN: 0887-8013; 1098-2825
• DOI: 10.1002/jcla.21792

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). Conclusion 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.