Clin Chem Lab Med 2015; 53(7): 1073–1076
Christoph Robier*, Daniela Klescher, Gerhard Reicht, Omid Amouzadeh-Ghadikolai, Franz Quehenberger and Manfred Neubauer
Dacryocytes are a common morphologic feature of autoimmune and microangiopathic haemolytic anaemia DOI 10.1515/cclm-2014-0936 Received September 22, 2014; accepted November 13, 2014; previously published online December 12, 2014
Abstract Background: Dacryocytes are teardrop-shaped erythrocytes which are most frequently observed in peripheral blood smears of patients with primary or secondary myelofibrosis as well as malignant infiltrative disorders of the bone marrow. Dacryocytes have rarely been described in blood smears of patients with autoimmune (AIHA) and microangiopathic haemolytic anaemia (MAHA). The clear prevalence of dacryocytes in AIHA and MAHA is unknown. Methods: We compared the dacryocyte counts in blood smears stained according to the May-Grünwald-Giemsa technique between 20 subjects with AIHA and MAHA with those from 21 controls. The dacryocytes, defined as erythrocytes tapered to a point at one end, were counted as cells per 20 high power fields (HPF) at 630-fold magnification. Results: In AIHA, MAHA and controls, dacryocytes were found in 89%, 91% and 19% of the slides, respectively. The rate of dacryocyte positivity and the dacryocyte counts between haemolytic anaemias and controls differed statistically highly significant (p 0.5% of the erythrocytes) as the predominating red blood cell shape abnormality [9] on the PB smear along with a negative Coombs test. Schistocytes were determined according to the recommendations of the International Council for Standardization in Hematology [9]. The MAHA group consisted of subjects diagnosed with thrombotic-thrombocytopenic purpura, haemolytic-uraemic syndrome, pregnancy-associated thrombotic microangiopathy (TMA), drug-, tumour- and chemotherapy-associated TMA as well as TMA due to extracorporal circulation. The control samples were obtained from in- and outpatients having normal PB counts without signs of HA. Exclusion criteria were laboratory and morphological features of thalassaemia (target cells, irregularly contracted cells), vitamin B12 or folic acid deficiency (macrocytes, macro-ovalocytes, hypersegmented granulocytes), myeloproliferative neoplasms (myeloid precursors, leukoerythroblastic changes) and myelodysplastic syndromes (blasts, neutrophil hypogranularity, acquired Pelger-Huet anomaly, dysplastic platelet features) [1], as well as the transfusion of packed red blood cells 6 months prior to study entry. Except from one patient with AIHA who had a positive transfusion history 4 weeks prior to recruitment, no further subjects had to be excluded. Blood smears were prepared from ethylene diamine tetraacetic acid anticoagulated blood (2.7 mL K EDTA, Sarstedt, Nuembrecht, Germany), stained according to the May-Grünwald-Giemsa technique, coded, and were finally examined in blinded fashion by light microscopy by an experienced analyst (CR). The dacryocytes, defined as erythrocytes tapered to a point at one end, resembling teardrops or pears [1, 10], were counted as cells per 20 high power fields (HPF) at 630-fold magnification (Zeiss Axioskop, Germany). Statistical calculations were performed with the program R 3.1.1 (www.r-project.org) using the package coin 1.1-0 for exact interference. Group comparisons with respect to continuous variables were assessed using the exact Wilcoxon test. Group comparisons with respect to categorical variables were assessed using Fisher’s exact test. p-Values
Christoph Robier*, Daniela Klescher, Gerhard Reicht, Omid Amouzadeh-Ghadikolai, Franz Quehenberger and Manfred Neubauer
Dacryocytes are a common morphologic feature of autoimmune and microangiopathic haemolytic anaemia DOI 10.1515/cclm-2014-0936 Received September 22, 2014; accepted November 13, 2014; previously published online December 12, 2014
Abstract Background: Dacryocytes are teardrop-shaped erythrocytes which are most frequently observed in peripheral blood smears of patients with primary or secondary myelofibrosis as well as malignant infiltrative disorders of the bone marrow. Dacryocytes have rarely been described in blood smears of patients with autoimmune (AIHA) and microangiopathic haemolytic anaemia (MAHA). The clear prevalence of dacryocytes in AIHA and MAHA is unknown. Methods: We compared the dacryocyte counts in blood smears stained according to the May-Grünwald-Giemsa technique between 20 subjects with AIHA and MAHA with those from 21 controls. The dacryocytes, defined as erythrocytes tapered to a point at one end, were counted as cells per 20 high power fields (HPF) at 630-fold magnification. Results: In AIHA, MAHA and controls, dacryocytes were found in 89%, 91% and 19% of the slides, respectively. The rate of dacryocyte positivity and the dacryocyte counts between haemolytic anaemias and controls differed statistically highly significant (p 0.5% of the erythrocytes) as the predominating red blood cell shape abnormality [9] on the PB smear along with a negative Coombs test. Schistocytes were determined according to the recommendations of the International Council for Standardization in Hematology [9]. The MAHA group consisted of subjects diagnosed with thrombotic-thrombocytopenic purpura, haemolytic-uraemic syndrome, pregnancy-associated thrombotic microangiopathy (TMA), drug-, tumour- and chemotherapy-associated TMA as well as TMA due to extracorporal circulation. The control samples were obtained from in- and outpatients having normal PB counts without signs of HA. Exclusion criteria were laboratory and morphological features of thalassaemia (target cells, irregularly contracted cells), vitamin B12 or folic acid deficiency (macrocytes, macro-ovalocytes, hypersegmented granulocytes), myeloproliferative neoplasms (myeloid precursors, leukoerythroblastic changes) and myelodysplastic syndromes (blasts, neutrophil hypogranularity, acquired Pelger-Huet anomaly, dysplastic platelet features) [1], as well as the transfusion of packed red blood cells 6 months prior to study entry. Except from one patient with AIHA who had a positive transfusion history 4 weeks prior to recruitment, no further subjects had to be excluded. Blood smears were prepared from ethylene diamine tetraacetic acid anticoagulated blood (2.7 mL K EDTA, Sarstedt, Nuembrecht, Germany), stained according to the May-Grünwald-Giemsa technique, coded, and were finally examined in blinded fashion by light microscopy by an experienced analyst (CR). The dacryocytes, defined as erythrocytes tapered to a point at one end, resembling teardrops or pears [1, 10], were counted as cells per 20 high power fields (HPF) at 630-fold magnification (Zeiss Axioskop, Germany). Statistical calculations were performed with the program R 3.1.1 (www.r-project.org) using the package coin 1.1-0 for exact interference. Group comparisons with respect to continuous variables were assessed using the exact Wilcoxon test. Group comparisons with respect to categorical variables were assessed using Fisher’s exact test. p-Values
