Schistocytes in disseminated intravascular coagulation.

INTRODUCTION: The presence of schistocytes on the peripheral blood film during disseminated intravascular coagulation (DIC) remains controversial. METHODS: We examined schistocytes count on blood films from 35 DIC patients and checked morphological anomalies of all RBCs. RESULTS: Thirty of 35 patients presented with schistocytes and 22 with acanthocytes, which was the commonest shape anomaly. Mean percentage ± standard deviation was 0.33 ± 0.38%, median value was 0.1%, and range was 0-1.4%. The patients with schistocytes ≥ 1% had circumstances frequently associated with increased schistocytes count (promyelocytic leukaemia, pregnancy, severe infection). DISCUSSION: Schistocytes were thus frequently observed in DIC patients, usually with low percentage, within or close to the reference range (<0.5%). Schistocytes measurement is not a clue test for the initial diagnosis of DIC, but might be of clinical value to suggest an associated or underlying thrombotic microangiopathy if ≥ 1%.

[Transient myeloproliferative disorder in a neonate without Down syndrome]. / Syndrome myélo-prolifératif transitoire chez un nouveau-né indemne de toute pathologie constitutionnelle.

We report a new case of transient myeloproliferative disorder (TMD) in a non Down syndrome neonate. The cytogenetic and molecular studies within from the blood blast cells identified a trisomy 21 and a partial deletion in exon 2 of the transcription factor GATA1. Spontaneous regression of the TMD was achieved at the age of 1 month as the clonal and molecular abnormalities. A survey by periodic cytological examinations of peripheral blood cells and GATA1 mutation analysis was instituted since three years and has not detected up to date acute leukaemia.

[Candidemia original diagnosis]. / Diagnostic original d'une candidémie.

We reported here a case of fungemia, which was diagnosed by a globular numeration: peripheral blood smears showed yeast cells, especially in the cytoplasm of neutrophils, with characteristic images of fungal phagocytosis. This test induced a prompt diagnosis of fungal septicaemia and the prescription of adapted treatment, which probably permitted to rescue the patient from a high mortality pathology.

[Role of platelet dysfunction in the haemostatic manifestations occurring during essential thrombocythaemia]. / Pathologies de l'hémostase liées aux plaquettes au cours de la thrombocyténie essentielle.

Among myeloproliferative disorders, Essential Thrombocythaemia is the most frequent and the one associated with the better prognosis. Although median survival is above 15 years, Essential Thrombocythaemia may be complicated by haemostatic life-threatening manifestations. Occurrence of thromboembolic or haemorrhagic episodes, even both in a same patient, are not predictable and physiopathology of Essential Thrombocythaemia remains misunderstood. Many studies have been conducted to explain the mechanisms responsible for the haemostatic complications and to determine predictive biological factors in order to improve the management of patients. We report here a review of the potential roles of platelets in Essential Thrombocythaemia through their interaction with coagulation and fibrinolysis systems as well as with cellular components (leukocytes and endothelium). Many controversial data have been published so far. However, a deficiency in high molecular multimers of von Willebrand factor is currently admitted, as well as deficiency of platelet membrane proteins and the presence of circulating activated platelets, especially in erythromelalgia. However, no biological abnormality has been correlated with the clinical manifestations. The haemostatic complications are likely to result from a multifactorial process in which accumulated moderated risk factors unbalance the procoagulant/anticoagulant pathways.

[Binucleated lymphocyte lymphocytosis]. / Lymphocytose à lymphocytes binuclées.

We reported here a case of persistent polyclonal B-cell lymphocytosis (PPBL) in a 31-year-old female patient. Peripheral blood smears showed atypical binucleated lymphocytes which were polyclonal B-cells with kappa and lambda expression, and without clonal rearrangement of immunoglobulin heavy chain. Cytogenetic analysis found a trisomy 8, with premature chromosome condensation. Clinically, PPBL is associated with moderated splenomegaly, adenopathy, and smoking. It remains to be established whether PPBL is a real pathology or a simple cytological abnormality.