Fragmented cells - Revision history

John at 13:52, 4 April 2023

2023-04-04T13:52:26Z

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John at 11:12, 13 March 2023

2023-03-13T11:12:03Z

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John at 11:10, 13 March 2023

2023-03-13T11:10:22Z

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	<span style="font-style:italic; font-size:90%;'' >		<span style="font-style:italic; font-size:90%;'' >
	'''''Clinical Image 1: Early fragmentation – note that for many cells there is still a resemblance to keratocytes. Other cells with membrane loss are also present (particularly spherocytes) and platelets are not seen. There is also polychromasia as the marrow responds to red cell loss. Clinical condition: thrombotic thrombocytopenic purpura.''		'''Clinical Image 1:''' Early fragmentation – note that for many cells there is still a resemblance to keratocytes. Other cells with membrane loss are also present (particularly spherocytes) and platelets are not seen. There is also polychromasia as the marrow responds to red cell loss. Clinical condition: thrombotic thrombocytopenic purpura.
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John at 11:09, 13 March 2023

2023-03-13T11:09:45Z

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	<span style="font-size:90%">		<span style="font-style:italic; font-size:90%;'' >
	'''''Clinical Image 1~~'''~~ Early fragmentation – note that for many cells there is still a resemblance to keratocytes. Other cells with membrane loss are also present (particularly spherocytes) and platelets are not seen. There is also polychromasia as the marrow responds to red cell loss. Clinical condition: thrombotic thrombocytopenic purpura.''		'''''Clinical Image 1: Early fragmentation – note that for many cells there is still a resemblance to keratocytes. Other cells with membrane loss are also present (particularly spherocytes) and platelets are not seen. There is also polychromasia as the marrow responds to red cell loss. Clinical condition: thrombotic thrombocytopenic purpura.''
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John at 11:08, 13 March 2023

2023-03-13T11:08:17Z

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	'''Significance'''		'''Significance'''

	Fragmented cells are not found in normal blood. Sharp fragments may reflect “microangiopathic” damage - this form of fragmentation may therefore represent a medical emergency and should be reported immediately. More rounded fragments arise in significant dyserythropoiesis (such as severe myelodysplasia, membrane disorder or megaloblastic states).		Fragmented cells are not found in normal blood. Sharp fragments may reflect “microangiopathic” damage - this form of fragmentation may therefore represent a medical emergency and should be reported immediately. More rounded fragments arise in significant dyserythropoiesis (such as severe myelodysplasia, membrane disorder or megaloblastic states), these are also important to diagnosis, but have a different origin.


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	'''Causes'''		'''Causes'''

	<div style="width: 95%; overflow: auto; border: 1px solid ~~black~~; font-size:~~120~~%">		<div style="width: 95%; overflow: auto; border: 1px solid navy; font-size:100%">
	{\| class="wikitable" style="color:black; background-color:#ffffff;" cellpadding="15"		{\| class="wikitable" style="color:black; background-color:#ffffff;" cellpadding="15"
	!colspan="1" \|'''Shearing processes''' (produce sharp fragments)		!colspan="1" \|'''Shearing processes''' (produce sharp fragments)

John at 11:06, 13 March 2023

2023-03-13T11:06:44Z

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	'''Appearance'''		'''Appearance'''

	Irregularly shaped red cell fragments, ~~often applied~~ to ~~cells~~ that are asymmetrical with sharp projections; more rounded fragments ~~may~~ have a different significance.		Irregularly shaped red cell fragments, it is useful to distimguish between fragments that are very asymmetrical with sharp projections; and the more rounded fragments that have a different clinical significance.

John at 11:05, 13 March 2023

2023-03-13T11:05:04Z

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	<span style="font-size:90%">		<span style="font-style:italic; font-size:90%;'' >
	'''''~~Image~~ 1''' These are the sharp fragmented forms that typically arise from fibrin-shearing of erythrocytes and may be regarded as the end stage of the same process that leads to keratocyte formation.''		'''''Images 1''' These are the sharp fragmented forms that typically arise from fibrin-shearing of erythrocytes and may be regarded as the end stage of the same process that leads to keratocyte formation.''
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	<span style="font-size:90%">		<span style="font-style:italic; font-size:90%;'' >
	'''''~~Image~~ 2''' More blunt or rounded fragments can arise in a range of disorders where there is membrane instability or damage.''		'''''Images 2''' More blunt or rounded fragments can arise in a range of disorders where there is membrane instability or damage.''
	</span>		</span>

John: Created page with " (schistocytes) '''Derivation:''' ''“schistos” [divided]'' ---- '''Appearance''' Irregularly shaped red cell fragments, often applied to cells that are asymmetrical with sharp projections; more rounded fragments may have a different significance. File:Fr1a.png|link={{filepath:Fr1a.png}} '''''Image 1''' These are the sharp fragmented forms that typically arise from fibrin-she..."

2023-02-19T19:05:13Z

Created page with " (schistocytes) '''Derivation:''' ''“schistos” [divided]'' ---- '''Appearance''' Irregularly shaped red cell fragments, often applied to cells that are asymmetrical with sharp projections; more rounded fragments may have a different significance. <gallery widths="180px" heights="180px" > File:Fr1a.png|link={{filepath:Fr1a.png}} </gallery> '''''Image 1''' These are the sharp fragmented forms that typically arise from fibrin-she..."

New page

(schistocytes)

'''Derivation:''' ''“schistos” [divided]''

----

'''Appearance'''

Irregularly shaped red cell fragments, often applied to cells that are asymmetrical with sharp projections; more rounded fragments may have a different significance.

<gallery widths="180px" heights="180px" >
File:Fr1a.png|link={{filepath:Fr1a.png}}
</gallery>


'''''Image 1''' These are the sharp fragmented forms that typically arise from fibrin-shearing of erythrocytes and may be regarded as the end stage of the same process that leads to keratocyte formation.''


<gallery widths="180px" heights="180px" >
File:Fr1b.png|link={{filepath:Fr1b.png}}
</gallery>


'''''Image 2''' More blunt or rounded fragments can arise in a range of disorders where there is membrane instability or damage.''


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'''Significance'''

Fragmented cells are not found in normal blood. Sharp fragments may reflect “microangiopathic” damage - this form of fragmentation may therefore represent a medical emergency and should be reported immediately. More rounded fragments arise in significant dyserythropoiesis (such as severe myelodysplasia, membrane disorder or megaloblastic states).

'''Pitfalls'''

Fragments are a “final pathological form” arising in a variety of processes. It is important when reporting these cells therefore, to reflect whether the film appearances represent a disorder where fragmentation is the primary pathological process (generally sharp ended), or whether the fragments are a reflection of cell fragility in a wider haematological disorder (generally rounded).

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'''Causes'''

<div style="width: 95%; overflow: auto; border: 1px solid black; font-size:120%">
{| class="wikitable" style="color:black; background-color:#ffffff;" cellpadding="15"
!colspan="1" |'''Shearing processes''' (produce sharp fragments)
|-
| '''Fibrin strands'''
|-
|Microangiopathic haemolysis: thrombotic thrombocytic purpura, haemolytic uraemic syndrome, pregnancy associated - HELLP syndrome (haemolysis, elevated liver enzymes and low platelet count), or pre-eclampsia.
|-
|Disseminated intravascular coagulation
|-
|Myelofibrosis
|-
|'''Turbulent blood flow'''
|-
|Valvular heart disease
|-
|Haemangiosarcoma
|-
!colspan="1"| '''Fragile erythrocytes'''
|-
|Congenital dyserythropoiesis
|-
|Myelodysplasia
|-
|Severe haematinic deficiency
|-
|Severe membrane disorder
|}
</div>

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'''Clinical examples'''

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'''''Clinical Image 1''' Early fragmentation – note that for many cells there is still a resemblance to keratocytes. Other cells with membrane loss are also present (particularly spherocytes) and platelets are not seen. There is also polychromasia as the marrow responds to red cell loss. Clinical condition: thrombotic thrombocytopenic purpura.''


<gallery widths="200px" heights="200px" >
File:Fr4.jpg|link={{filepath:Fr4.jpg}}
</gallery>


'''''Clinical Image 2''' Established fragmentation –the damaged red cells are very angular having undergone several cycles of damage. The resemblance to keratocytes is now much less marked. Clinical condition: thrombotic thrombocytopenic purpura.''


<gallery widths="200px" heights="200px" >
File:Fr5.jpg|link={{filepath:Fr5.jpg}}
</gallery>


'''''Clinical Image 3''' "Blunt fragments” - note that the context is different with few normal cells present, and that the fragments have a rounded and often quite varied shape reflecting membrane fragility. Clinical condition: megaloblastic anaemia (deficiency of vitamin B12).''


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File:Fr6.jpg|link={{filepath:Fr6.jpg}}
</gallery>


'''''Clinical Image 4''' "Blunt fragments” - like the previous example the fragments form part of a broad distribution of abnormal cell shapes that are rounded and often with irregular projections reflecting their abnormal fragility and formation. Clinical condition: thalassaemia intermedia.''


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'''Pathobiology'''

Fibrin deposition in small vessels causes mechanical “shearing” of red cells (this may also be a feature of severely turbulent flow of blood e.g. damaged heart valves). The fragmented cells arising from this mechanism should be viewed as a more severely damaged form of the keratocyte (which will often also be present). A second more rounded form of fragment arises in an intrinsically fragile red cell, where it is thought to represent membrane instability – here the fragments appear different and keratocytes are not generally present - look instead for features of severe inherited membrane disorder or dyserthropoietic states.

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