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A hospital laboratory is sent blood samples from six patients with six different diagnoses. A blood smear from one sample shows a reduced number of normochromic, normocytic erythrocytes, with numerous schistocytes. This blood sample has been probably drawn from the patient with A. acute blood loss
B. chronic autoimmune gastritis
C. disseminated intravascular coagulation
D. immune-mediated hemolysis
E. iron deficiency
F. thalassemia minor
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D. immune-mediated hemolysis
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CCC
Schistocytes usually are caused when red cells hit a sharp surface such as a fibrin strand or abnormal cardiac valve. They are often associated with hemolytic conditions such as microangiopathic hemolytic anemia, DIC, burns, etc
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ccccccccccccccccc...................schistocytes are key finding in DIC
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The correct answer is C. Simply put, schistocytes are fragments of red blood cells of different shapes and sizes. They are derived from mechanical damage to circulating erythrocytes, which results in a form of anemia referred to as microangiopathic hemolytic anemia. There are two main causes of this form of anemia: disseminated intravascular coagulation (DIC) and prosthetic valves. DIC is due to widespread and uncontrolled activation of the coagulation cascade, leading to formation of microthrombi throughout the circulation. Erythrocytes become fragmented as they squeeze through narrowed arterioles and capillaries.
Immune-mediated hemolysis (choice D) is due to agglutinins that can be classified as warm (IgG type) or cold (IgM type) according to whether the Coombs test is positive at 37 C or 0-4 C. Agglutinins binding red blood cells may cause acute or chronic anemia by intravascular or extravascular coagulation. Unconjugated hyperbilirubinemia is usually present, and the anemia is normochromic and normocytic. Schistocytes are not observed.
