{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:34:29Z","timestamp":1786649669412,"version":"build-2736575974"},"reference-count":9,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,4]]},"abstract":"ABSTRACT<\/jats:title>\n \n Introduction:<\/jats:title>\n Automated hematology analyzers determine the fragmented red cells on the reticulocyte scattergram. The study was taken up to evaluate the accuracy of automated fragmented red cell (FRC%) counting in hemolytic anemia and to analyze the effect of interference of microcytosis and poikilocytosis on automated FRC counting.<\/jats:p>\n <\/jats:sec>\n \n Materials and Methods:<\/jats:title>\n The study recruited cases of extravascular hemolysis, intravascular hemolysis, and microcytic hypochromic anemia (MHA). The automated FRC%, indices of microcytosis (mean corpuscular volume [MCV], percentage of microcytic red cells [Micro R%]), and anisopoikilocytosis (Red Cell Distribution Width-Coefficient of variation [RDW-CV]) were determined by the Mindray BC-6200 analyzer. The manual FRC count was compared with the automated FRC% in each group.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Bland\u2013Altman plot suggested a high degree of agreement between manual and automated FRC% in intravascular hemolysis, with a cut-off of 0.94% for FRC% by receiver operating curve with 96.6% sensitivity and 100% specificity. Anisopoikilocytosis (measured by RDW-CV) showed positive linear correlation with FRC% in extravascular hemolysis (\n r<\/jats:italic>\n = 0.812,\n P<\/jats:italic>\n < 0.001) and in MHA (\n r<\/jats:italic>\n = 0.552,\n P<\/jats:italic>\n < 0.001), with no correlation in intravascular hemolysis (\n r<\/jats:italic>\n = 0.295,\n P<\/jats:italic>\n = 0.121). Microcytosis (measured by Micro R%) showed no correlation with FRC% in extravascular and intravascular hemolysis (\n P<\/jats:italic>\n = 0.177 and\n P<\/jats:italic>\n = 0.490, respectively), but showed a moderate positive correlation in MHA (\n r<\/jats:italic>\n = 0.461,\n P<\/jats:italic>\n < 0.001). Whereas, FRC% showed a mild negative correlation with MCV in MHA (\n r<\/jats:italic>\n = \u22120.384,\n P<\/jats:italic>\n < 0.001). The results suggest an interference of microcytosis and anisopoikilocytosis with automated FRC counting.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n The study recommends FRC% as a reliable parameter for indicating schistocytes in intravascular hemolysis, while there is an overestimation of FRC% in extravascular hemolysis due to anisopoikilocytosis. Caution must be exercised while interpreting FRC%, warranting a slide review to confirm the presence of schistocytes in cases with microcytosis and anisopoikilocytosis.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/ijpm.ijpm_912_25","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T11:07:12Z","timestamp":1777374432000},"page":"263-268","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Automated fragmented red cell (FRC) counting in hemolytic anemia: Do poikilocytes and microcytes interfere?"],"prefix":"10.4103","volume":"69","author":[{"given":"BR","family":"Rajalakshmi","sequence":"first","affiliation":[{"name":"Department of Pathology, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelby P.","family":"Kunjukunju","sequence":"additional","affiliation":[{"name":"Department of Pathology, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Suchitha","sequence":"additional","affiliation":[{"name":"Department of Pathology, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MC Sapna","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Pathology, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"key":"R1-20260707","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1111\/ijlh.12023","article-title":"Evaluation of fragmented red cell (FRC) counting 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to exclude schistocytes on the blood film","volume":"34","author":"Lesesve","year":"2012","journal-title":"Int J Lab Hematol"},{"key":"R6-20260707","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1111\/ijlh.12364","article-title":"Fragmented red cells reference range for the Sysmex XN\u00ae-series of automated blood cell counters","volume":"37","author":"Lesesve","year":"2015","journal-title":"Int J Lab Hematol"},{"key":"R7-20260707","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1111\/j.1751-553X.2011.01380.x","article-title":"ICSH recommendations for identification, diagnostic value, and quantitation of schistocytes","volume":"34","author":"Zini","year":"2012","journal-title":"Int J Lab Hematol"},{"key":"R8-20260707","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1309\/MY7077989KWDYP88","article-title":"Comparative evaluation of schistocyte counting by an automated method and by microscopic determination","volume":"121","author":"Lesesve","year":"2004","journal-title":"Am J Clin Pathol"},{"key":"R9-20260707","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1038\/sj.bmt.1704601","article-title":"Automated measurement of schistocytes after bone marrow transplantation","volume":"34","author":"Lesesve","year":"2004","journal-title":"Bone Marrow Transplant"},{"key":"R10-20260707","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1007\/s13312-017-1113-3","article-title":"Novel automated hematology parameters in clinical pediatric practice","volume":"54","author":"Rastogi","year":"2017","journal-title":"Indian Pediatr"}],"container-title":["Indian Journal of Pathology and Microbiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ijpm.ijpm_912_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T18:56:45Z","timestamp":1786647405000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ijpm.ijpm_912_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":9,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/ijpm.ijpm_912_25","relation":{},"ISSN":["0377-4929","0974-5130"],"issn-type":[{"value":"0377-4929","type":"print"},{"value":"0974-5130","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"2025-09-08","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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