ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on Twitter

Kidney Week

Abstract: PO1908

Deceiving Schistocytes

Session Information

Category: Onco-Nephrology

  • 1500 Onco-Nephrology


  • Gonçalves, Catarina Abrantes, Centro Hospitalar de Setubal EPE, Setubal, Setúbal, Portugal
  • Furtado, Maria Teresa, Centro Hospitalar de Setubal EPE, Setubal, Setúbal, Portugal
  • Domingues, Patrícia Andreia da Costa, Centro Hospitalar de Setubal EPE, Setubal, Setúbal, Portugal
  • Piedade, Ana D., Centro Hospitalar de Setubal EPE, Setubal, Setúbal, Portugal
  • Natario, Ana, Centro Hospitalar de Setubal EPE, Setubal, Setúbal, Portugal

Myelodysplastic syndrome (MDS) is a clone bone marrow disorder characterized by dyshematopoiesis, which may manifest as cytopenias and non-immune hemolytic anemia. Schistocytes are commonly associated with causes of microangiopathic hemolytic anemia (MAHA), however, schistocytosis with a high reticulocyte count in the peripheral blood smear is a rare and unusual manifestation of MDS.

Case Description

We report the case of a 63-year-old male who presented with complaints of asthenia, fatigue and malaise for the past 3 months. His previous medical history included a past of heavy smoking, arterial hypertension and grade 3 chronic kidney disease (CKD) developed after nephrectomy due to urothelial carcinoma in 2012. He also had in situ papillary urothelial carcinoma of the bladder in 2016, with a course of intra-vesical mitomycin. Vital signs were normal and physical examination was unremarkable. Blood work revealed macrocytic anemia (hemoglobin 7.2g/dL; MGV 101fL) and thrombocytopenia (77.000/μL) and peripheral blood smear demonstrated 16% schistocytes, with normal coagulation tests, lactate dehydrogenase and haptoglobin. Coombs test was negative. Renal function was stable and there was no evidence of hematoproteinuria. Inflammatory markers were negative. A diagnosis of microangiopathic anemia was assumed and the patient was started on daily plasmapheresis and steroids, while further investigation was under way. Folate and cobalamin levels were normal, anti-nuclear antibodies and HIV, hepatitis B and C serologies were negative and full-body CT scan did not show signs of occult malignancy. Levels of C3 and C4 were also within the normal range. ADAMTS-13 activity was 21%. No clinical or analytical improvement was noted after 6 sessions of plasmapheresis (platelet count nadir of 38.000/μL and persistence of schistocytosis). Bone marrow biopsy was performed and a diagnosis of refractory anemia with excess blasts was made.


Hemolytic anemia is a common occurrence in patients with hematologic malignancies, particularly acute and chronic myeloid leukemia, but are rarely observed in MDS, with only a few cases reported in the literature. This case highlights the importance of considering a diagnosis of MDS in patients presenting with refractory cytopenias and MAHA.