Clinical and morphological practices in the diagnosis of transplant-associated microangiopathy: a study on behalf of Transplant Complications Working Party of the EBMT

Ivan S Moiseev, Tatyana Tsvetkova, Mahmoud Aljurf, Randa M Alnounou, Janet Bogardt, Yves Chalandon, Mikhail Yu Drokov, Valentina Dvirnyk, Maura Faraci, Lone Smidstrup Friis, Fabio Giglio, Hildegard T Greinix, Brian Thomas Kornblit, Christiane Koelper, Christian Koenecke, Krzysztof Lewandowski, Dietger Niederwieser, Jakob R Passweg, Christophe Peczynski, Olaf PenackZinaida Peric, Agnieszka Piekarska, Paola Erminia Ronchi, Alicia Rovo, Piotr Rzepecki, Francesca Scuderi, Daniel Sigrist, Sanna M Siitonen, Friedrich Stoelzel, Kazimierz Sulek, Dimitrios A Tsakiris, Urszula Wilkowojska, Rafael F Duarte, Tapani Ruutu, Grzegorz W Basak

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Abstract

Transplant-associated thrombotic microangiopathy (TA-TMA) is a life-threatening complication of allogeneic hematopoietic stem cell transplantation (HSCT). This study evaluated clinical and morphological practices of TA-TMA diagnosis in EBMT centers. Two questionnaires, one for transplant physician and one for morphologist, and also a set of electronic blood slides from 10 patients with TA-TMA and 10 control patients with various erythrocyte abnormalities, were implemented for evaluation. Seventeen EBMT centers participated in the study. Regarding criteria used for TA-TMA diagnosis, centers reported as follows: 41% of centers used the International Working Group (IWG) criteria, 41% used "overall TA-TMA" criteria and 18% used physician's decision. The threshold of schistocytes to establish TA-TMA diagnosis in the participating centers was significantly associated with morphological results of test cases evaluations (p = 0.002). The mean number of schistocytes reported from blood slide analyses were 4.3 ± 4.5% for TA-TMA cases (range 0-19.6%, coefficient of variation (CV) 0.7) and 1.3 ± 1.6% for control cases (range 0-8.3%, CV 0.8). Half of the centers reported schistocyte levels below 4% for 7/10 TA-TMA cases. The intracenter variability was low, indicating differences in the institutional practices of morphological evaluation. In conclusion, the survey identified the need for the standardization of TA-TMA morphological diagnosis.

Original languageEnglish
Pages (from-to)1022-1028
Number of pages7
JournalBone Marrow Transplantation
Volume54
Issue number7
DOIs
Publication statusPublished - Jul 2019

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Moiseev, I. S., Tsvetkova, T., Aljurf, M., Alnounou, R. M., Bogardt, J., Chalandon, Y., Drokov, M. Y., Dvirnyk, V., Faraci, M., Friis, L. S., Giglio, F., Greinix, H. T., Kornblit, B. T., Koelper, C., Koenecke, C., Lewandowski, K., Niederwieser, D., Passweg, J. R., Peczynski, C., ... Basak, G. W. (2019). Clinical and morphological practices in the diagnosis of transplant-associated microangiopathy: a study on behalf of Transplant Complications Working Party of the EBMT. Bone Marrow Transplantation, 54(7), 1022-1028. https://doi.org/10.1038/s41409-018-0374-3