Evaluation of Schistocytosis in Patients Treated with Dialysis

Schistocytes are associated with micro angiopathic hemolytic processes. In this retrospective study; we evaluate the association ofschistocytosis in the peripheral blood smear of patients before and after dialysis. We identified 7000 patients in our hospital system that underwent dialysis. The peripheral blood smears of 153 who were evaluable for the presence of schistocytosis prior to and after dialysis. Ninety seven patients had alternative reasons to have schistocytosis. Among the remaining 50 patients, 14% had schistocytes present prior to begin dialysis and 86% after one or more dialysis episodes. We conclude that the presence of schistocytes in the peripheral blood prior to dialysis is likely due to the underlying cause of renal impairment or other co-morbidity. However, upon initiation of dialysis the proportion of patients with schistocytosis is markedly increased and is likely due to the fragmentation of red cells during the dialysis procedure.