CASE: A 30 yo F with no significant PMH presents with fatigue and was found to have a hct of 18% and platelets of 9. Her coagulation panel was normal, LDH elevated and haptoglobin was low. A peripheral smear below shows:
What does the above image show?
The above peripheral blood smear shows evidence of schistoctyes.
What disorders as also associated with schistocytes?
Schistocytes can be seen in the following disorders:
- Thrombotic microangiopathies (HUS, TTP)
- Prosthetic heart valve, VADs
- HELLP syndrome
- Less commonly, schistocytes can be seen in:
- HSCT or solid organ transplant patients
- Severe hypertension
- Systemic infection
She was diagnosed with TTP and was treated with high dose IV methylprednisolone x 3 days and plasmapharesis x 3 days. An ADAMTS13 level ultimately came back at 0%, consistent with ADAMTS13 deficiency or hereditary TTP. She was maintained on FFP transfusions as an outpatient.