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Reference Range for the Automated Fragmented Red Cell Parameter and Its Diagnostic Utility in Red Blood Cell (RBC)

Ginni Bharti1, Tushar Sehgal1, Hemchandra Pandey2

  • 1Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, IND.

Cureus
|September 29, 2025
PubMed
Summary
This summary is machine-generated.

Automated fragmented red blood cell (FRC) counts can help exclude over two-thirds of samples from manual schistocyte review, improving lab efficiency. Establishing instrument-specific reference ranges is crucial for accurate interpretation in diagnosing microangiopathies.

Keywords:
blood film microscopyfragmented red blood cellshematology analyserhemolytic uremic syndrome (hus)laboratory automationreference rangettp (thrombotic thrombocytopenic purpura)

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Area of Science:

  • Hematology
  • Clinical Pathology
  • Laboratory Medicine

Background:

  • Fragmented red blood cells (FRCs) are a new parameter on hematology analyzers, potentially correlating with schistocytes.
  • Schistocytes are critical for diagnosing thrombotic microangiopathies but manual counting is time-consuming.
  • Automated FRC measurement accuracy varies by analyzer, necessitating instrument-specific reference ranges.

Purpose of the Study:

  • To establish a reference range for automated FRC measurements.
  • To evaluate the correlation between automated FRC counts and manual schistocyte counts.
  • To assess FRC as a potential screening tool for schistocytes.

Main Methods:

  • 179 normal blood donor samples analyzed on XN-Series™ analyzers to establish FRC reference ranges.
  • Evaluation of other red blood cell parameters' influence on FRC.
  • 100 patient samples compared automated FRC with manual schistocyte counts using Bland-Altman analysis.

Main Results:

  • Reference interval for FRC# was 0.0-0.125/µL; for FRC% was 0.0-0.00515%.
  • Elevated Hypo-He values showed spurious FRC increases.
  • An FRC% threshold of <1% had a 70% negative predictive value for schistocytes; moderate agreement (bias 0.287, 95% LoA -2.2 to 2.8) with manual counts.

Conclusions:

  • Established FRC reference ranges improve clinical interpretation and analyzer refinement.
  • FRC can serve as a screening tool, potentially excluding 70% of samples from manual review, enhancing lab efficiency.
  • Elevated FRCs can trigger manual smear review, aiding in suspected thrombotic microangiopathic anemia cases.