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Neonates with suspected microangiopathic disorders: performance of standard manual schistocyte enumeration vs. the automated fragmented red cell count

Journal of Perinatology volume 39, pages 1555–1561 (2019)Cite this article

Subjects

Abstract

Objectives

To enhance the diagnosis of schistocyte-producing conditions, we compared routine manual schistocyte enumeration with automated fragmented red cell counts (FRCs).

Study design

In neonates “suspected” of having sepsis, NEC, or DIC we compared manual schistocyte estimates vs. automated FRC counts. When the two disagreed, we used a “gold standard” from a  ≥ 1000 RBC differential. We also assessed the diagnostic accuracy of the FRC count in diagnosing sepsis, NEC, or DIC.

Results

We collected 270 CBCs from 90 neonates. The methods agreed in 63% (95% CI 55%–70%) of the CBCs. Among the 37% where they disagreed, the FRC count was more accurate in 100% (95% CI 88–100%). An elevated FRC count was specific for sepsis, and was sensitive and specific for necrotizing enterocolitis and DIC.

Conclusions

Automated FRC counts have advantages over routine manual evaluation, larger sample size, lower expense, and superior accuracy in diagnosing schistocyte-producing conditions.

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Acknowledgements

We thank Dr. Phillip V. Gordon, Pensacola, Florida for reviewing the manuscript, and Dr. Jolanta Kunicka of Sysmex America Inc. for helpful discussions on the FRC parameter. We also thank the neonatologists who helped with this study: Mark Sheffield, MD, McKay-Dee Hospital, Ogden, UT; Con Yee Ling, MD, Primary Children’s Hospital, Salt Lake City, UT; Elizabeth O’Brien, Intermountain Medical Center, Murray, UT; Shaun O’Dell, MD, Utah Valley Regional Medical Center, Provo, UT; and Patrick Carroll, MD, Dixie Regional Medical Center, St. George, UT. We also thank our NICU research nurses for their invaluable assistance with this study; Melody Parry, RN, McKay-Dee Hospital; Kimberlee Weaver Lewis, RN and Trisha Marchant, RN, Intermountain Medical Center; Susan Christensen, RN and Jennifer Elmont, RN, Utah Valley Regional Medical Center.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Neonatology, University of Utah Health, Salt Lake City, UT, USA

    Timothy M. Bahr, Allison J. Judkins & Robert D. Christensen

  2. Women and Newborn’s Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA

    Robert D. Christensen, Vickie L. Baer, Erick Henry, Stephen D. Minton & Erick Gerday

  3. Department of Pediatrics, Division of Hematology/Oncology, University of Utah Health, Salt Lake City, UT, USA

    Robert D. Christensen

  4. Department of Pediatrics, Division of Neonatology, Utah Valley Hospital, Provo, UT, USA

    Stephen D. Minton & Erick Gerday

  5. Department of Pathology, Intermountain Medical Center, Murray, UT, USA

    Sterling T. Bennett

Authors
  1. Timothy M. Bahr
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  2. Allison J. Judkins
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Correspondence to Timothy M. Bahr.

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Bahr, T.M., Judkins, A.J., Christensen, R.D. et al. Neonates with suspected microangiopathic disorders: performance of standard manual schistocyte enumeration vs. the automated fragmented red cell count. J Perinatol 39, 1555–1561 (2019). https://doi.org/10.1038/s41372-019-0482-y

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