Hi doctor, My friend recently got a blood test done and they told her that she had a large number of schistocytes. However, she was not found to be anemic and has no other history of serious health issues. She is 30 and thin built. She has been anemic on blood tests occasionally in the past. I do not know if it is related. They also did a CT scan because of abdominal pain and found a 10 mm lesion on her liver and inflammation of her uterus and stomach. She saw her gynecologist for an annual checkup last month and everything was normal. She had some acid reflux and gastritis problems on and off in the past. She also has been using the NuvaRing birth control for the past two years. They recommended her to see an oncologist for the liver lesion and a gastrointestinal specialist for the stomach inflammation. My question is, everything I have read about schistocytes says that they are caused by either trauma or by disorders that cause persistent anemia. Since she was not anemic, what could be the cause for schistocytes?
Hi. I have gone through your query and can understand your concern. Schistocytes are nothing but fragmented or broken red blood cells, which are formed due to trauma to the cells. There are many causes of schistocytes in blood, One of the causes is microangiopathic hemolytic anemia. But, you have mentioned that she is not anemic. Other causes are thrombotic thrombocytopenic purpura and hemolytic-uremic syndrome in which there is a defect in platelets and fibrin, which causes destruction of RBC's. But, in these conditions the peripheral smear will show other abnormalities in platelets also. Other causes are aortic stenosis and prosthetic valve. As she has lesion in liver, I suggest to get her evaluated properly as some systemic diseases and malignancy can also cause disseminated intravascular coagulation and destruction of RBC's. In my opinion, she needs liver function test, kidney function test and ultrasound of the abdomen to confirm the diagnosis. Also, get her ECG and 2D echocardiogram done. If the morphology of liver lesion will become clear, then it will be easier to reach the diagnosis. For further information consult an internal medicine physician online -->