Neonates with suspected microangiopathic disorders: performance of standard manual schistocyte enumeration vs. the automated fragmented red cell count

Objectivesto enhance the diagnosis of schistocyte-producing conditions, we compared routine manual schistocyte enumeration with automated fragmented red cell counts (frcs).study designin neonates “suspected” of having sepsis, nec, or dic we compared manual schistocyte estimates vs. automated frc counts. when the two disagreed, we used a “gold standard” from a  ≥ 1000 rbc differential. we also assessed the diagnostic accuracy of the frc count in diagnosing sepsis, nec, or dic.resultswe collected 270 cbcs from 90 neonates. the methods agreed in 63% (95% ci 55%–70%) of the cbcs. among the 37% where they disagreed, the frc count was more accurate in 100% (95% ci 88–100%). an elevated frc count was specific for sepsis, and was sensitive and specific for necrotizing enterocolitis and dic.conclusionsautomated frc counts have advantages over routine manual evaluation, larger sample size, lower expense, and superior accuracy in diagnosing schistocyte-producing conditions.