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The fragmented red cell count can support the diagnosis of a microangiopathic neonatal condition

Journal of Perinatology volume 40, pages 354–355 (2020)Cite this article

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In recent publications we proposed merit in measuring the Fragmented Red Cell (FRC) count in NICU patients [1, 2]. Though it is not yet FDA approved in the U.S.A., this parameter is available on Sysmex and Siemens ADVIA analyzers, and is included on every CBC with no additional phlebotomy volume or run-time. With IRB approval, we can retrieve the FRC count retrospectively as a research-only parameter. In doing this we discover instances where we conclude that had we known the FRC count in real-time, that information would have guided us to a more rapid diagnosis. The purpose of this letter is to briefly report three such cases.

Case 2: A near-term male born after nonreassuring fetal heart tones required endotracheal intubation and ventilation at birth. Within 1 h bilateral pneumothoraces were identified and chest tubes were placed, with marked bleeding around and into the tubes. He was transported emergently to the children’s hospital where ECMO was instituted. He had continuous bleeding and oozing on ECMO. Laboratory studies before and after beginning ECMO included elevations of D-dimers (>5500 ng/mL), prolonged partial thromboplastin times (>150 s), and prothrombin times (>18 s) and low fibrinogen levels (<200 mg/dL). In light of the continuous hemorrhaging it was decided by the family and the medical team to discontinue life support. DIC is a microangiopathic disorder, with intravascular fibrin stranding and schistocyte creation, thus the FRC becomes elevated [3, 4]. The markedly elevated FRC counts support the diagnosis of DIC (Fig. 1b).

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Fig. 1

References

  1. Judkins AJ, MacQueen BC, Christensen RD, Henry E, Snow GL, Bennett ST. Automated quantification of fragmented red blood cells: neonatal reference intervals and clinical disorders of neonatal intensive care units patients with high values. Neonatology. 2018;115:5–12.

    Article  Google Scholar 

  2. Bahr TM, Judkins AJ, Christensen RD, Baer VL, Henry E, Minton SD, et al. Neonates with suspected microangiopathic disorders: performance of standard manual schistocyte enumeration vs. the automated fragmented red cell count. J Perinatol. 2019;39:1555–61.

    Article  Google Scholar 

  3. Lesesve JF, Asnafi V, Braun F, Zini G. Fragmented red blood cells automated measurement is a useful parameter to exclude schistocytes on the blood film. Int J Lab Hematol. 2012;34:566–76.

    Article  Google Scholar 

  4. Lesesve JF, Fenneteau O, Zini G. Schistocytes. Transfusion. 2014;54:1459.

    Article  Google Scholar 

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Authors and Affiliations

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

    Timothy M. Bahr, Allison J. Judkins, Peter H. Grubb, Whitley Hulse & Robert D. Christensen

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

    Vickie L. Baer, Erick Henry & Robert D. Christensen

  3. Division of Pediatric Pathology, Department of Pathology, University of Utah Health and Primary Children’s Hospital, Salt Lake City, UT, USA

    Theodore J. Pysher

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

    Sterling T. Bennett

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

    Robert D. Christensen

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  1. Timothy M. Bahr
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  2. Allison J. Judkins
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  4. Erick Henry
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  8. Sterling T. Bennett
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  9. Robert D. Christensen
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Correspondence to Timothy M. Bahr.

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Bahr, T.M., Judkins, A.J., Baer, V.L. et al. The fragmented red cell count can support the diagnosis of a microangiopathic neonatal condition. J Perinatol 40, 354–355 (2020). https://doi.org/10.1038/s41372-019-0552-1

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