Schistocytosis refers to traumatized erythrocytes that take on a variety of shapes (helmet cells, triangular, fragments). This may be an early sign of a life-threatening disease.


Recognized causes of schistocytosis:

(1) micro-angiopathic hemolytic anemia: fragmentation in capillaries and small arterioles associated with DIC or TTP/HUS

(2) vasculitis: autoimmune vs infectious

(3) heart valves - prosthetic or with distorted native valves

(4) pregnancy-related: eclampsia, HELLP syndrome

(5) march hemoglobinuria, runner's anemia

(6) severe burns

(7) snakebite

(8) chemical or toxic drug exposure

(9) giant cavernous hemangioma


Differential diagnosis - red cell disorders without trauma to erythrocytes:

(1) unstable hemoglobin - sickle cell anemia, sickle-thalassemia, other hemoglobinopathy

(2) iron deficiency anemia - The poikilocytosis with circulating red cell fragments associated with iron deficiency anemia may be mislabeled as schistocytosis. However, iron deficiency may arise with chronic intravascular hemolytic anemias.


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