EVALUATION OF COMBINED MEASUREMENT OF IMMATURE PLATELET FRACTION AND SCHISTOCYTES IN PREGNANCY-ASSOCIATED THROMBOTIC THROMBOCYTOPENIC PURPURA AND SEVERE PREECLAMPSIA/ HELLP SYNDROME
Author(s): ,
Mary Fayek
Affiliations:
Clinical Pathology,Misr University for Science and Technology,Cairo,Egypt
,
Mohamed Mekawy
Affiliations:
Clinical Pathology Department,Ain Shams University,Cairo,Egypt
,
Rasha El-Gamal
Affiliations:
Clinical Pathology Department,Ain Shams University,Cairo,Egypt
,
Ayman Abdelkader
Affiliations:
Obstetrics and Gynecology Department,Ain Shams University,Cairo,Egypt
Haitham Abdelbary
Affiliations:
Clinical Hematology and Bone Marrow Transplantation Unit,Ain Shams University Hospital,Cairo,Egypt
EHA Library. El-Gamal R. Jun 15, 2019; 267095; PS1478
Rasha El-Gamal
Rasha El-Gamal
Contributions
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Abstract

Abstract: PS1478

Type: Poster Presentation

Presentation during EHA24: On Saturday, June 15, 2019 from 17:30 - 19:00

Location: Poster area

Background
The occurrence of thrombotic microangiopathy (TMA) in pregnancy is an unfortunate emergency condition. Proper diagnosis is mandatory which requires the consideration of two overlapping diagnoses: severe preeclampsia/ haemolysis, elevated liver enzymes, and low platelet syndrome (SPE/HELLP) and thrombotic thrombocytopenic purpura (TTP). The long turn-around times of ADAMTS13 testing precludes the timely distinction between the two conditions. 

Aims
We aimed at evaluating schistocyte counts and immature platelet fraction (IPF%), as both increase in TMAs, to discriminate between TTP and SPE/HELLP of pregnancy.

Methods
IPF% was measured using SysmexXE-2100 automated hematology analyzer, and schistocyte counts were estimated microscopically as per the International Council for Standardization in Hematology (ICSH)-Schistocyte Working Group guidelines. The study included 30 pregnant patients with SPE/HELLP, 13 pregnant patients with TTP, and 30 women with normal pregnancy. The discrimination between the two patient categories was based on clinical judgment and TTP cases were identified using the PLASMIC score. 

Results
TTP patients had higher values of IPF% than SPE/HELLP 19.5 (16.9–27.1) vs 13 (9.5 – 23.25); p <0.001); similar results were revealed regarding schistocyte counts 6.5 (3.9–8.6) vs 2.1 (1.6 – 3.5); p <0.001). IPF% and schistocyte counts were able to discriminate between TMA patients and normal pregnant women, and between and SPE/HELLP and TTP patients. Moreover, the discriminatory function of each was improved when the two parameters were used in combination. 

Conclusion

IPF% analysis should be used in conjunction with manual schistocyte counting in TMA cases to distinguish TTP pregnant patients from patients having SPE/HELLP.

Session topic: 32. Platelets disorders

Keyword(s): ADAMTS13, Pregnancy, Thrombotic microangiopathy, TTP

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