Schistocytosis is not always microangiopathic hemolytic anemia

This chapter discusses a case study of a 75-year-old woman who was presented elsewhere with gradually increasing shortness of breath, weight loss and anorexia. Her blood count showed anemia and mild thrombocytopenia and a blood film showed red cell fragments (schistocytes). Thrombotic thrombocytopenic purpura (TTP) was suspected and the patient was referred for plasma exchange. Rapid diagnosis and treatment of TTP is important and the index of suspicion must be high. However, it is important to be aware of other causes of schistocytosis. The dyserythropoiesis of a myelodysplastic syndrome can lead to the presence of schistocytes and doctors are aware of another patient with MDS in whom plasma exchange for suspected TTP was carried out before bone marrow examination revealed the correct diagnosis. Severe megaloblastic anemia can also have marked schistocytosis so that TTP is suspected.