Disseminated intravascular coagulation (DIC) and thrombotic thrombocytopenic purpura (TTP) were excluded by the lack of significant schistocytosis
on a peripheral blood review and normal ADAMTS13 activity.
Laboratory analysis revealed severe hemolytic anemia with schistocytosis
The peripheral blood smear showed moderate schistocytosis
and moderate polychromasia, in keeping with haemolysis (Table 1).
Our main hypothesis had remained a thrombotic microangiopathy despite the absence of peripheral schistocytosis
and intrasplenic TMA was finally confirmed by these vascular lesions.
A peripheral blood smear was negative for any schistocytosis
. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin, and direct bilirubin were all within normal limits.
Moderate to severe schistocytosis
was present in all cases and other laboratory features are shown in Table-I.
(2+) was revealed upon peripheral blood smear.
TTP was diagnosed in this patient owing to the presence of thrombocytopenia, MAHA with schistocytes of 3% and neurological manifestations.!91 Systemic bacterial and fungal infections were excluded with several negative blood cultures, as severe sepsis is one of the differentials for schistocytosis
Course of TMA is often variable, because classical laboratory parameters are not always found (anemia, thrombocytopenia, elevated plasma lactate dehydrogenase, low serum haptoglobin, and schistocytosis
), Sometimes development of hypertension in previously normotensive patient or worsening of preexisting hypertension may help with the diagnosis of TMA.
Clinical and paraclinical findings, including chest pain, fever, respiratory distress, abnormal liver function, coagulopathy, thrombocytopenia, and schistocytosis
, are explainable with thrombotic microangiopathy in this patient.
TMA associated with VEGF/VEGFr inhibitors was mostly localized to the kidney, and systemic manifestations (e.g., thrombocytopenia or schistocytosis
) were present only in half of these patients .
Poikilocytosis, anisocytosis, schistocytosis
, spherocytosis, target cells, and few thrombocytes were observed in the blood smear.