BACKGROUND: The schistocytes are fragmented red blood cells mainly observed in the setting of hemolytic anemias where they remain an important criterion for the diagnosis. As the identification of these cells is still problematic, the International Council for Standardization in Hematology (ICSH) set up a consensus report in November, 2011. The French Group of Cellular Hematology (GFHC) aimed to collect the opinion of French biologists directly confronted to schistocytes measurements, about these guidelines.
METHODS: Among the 578 professionals, 169 (29%) answered to the 10 questions dealing with the identification and measurements of schistocytes as proposed by the ICSH.
RESULTS: A consensus was reached for the urgent need of such guidelines documents, especially in the current background of the European accreditation EN ISO 15189 rules. A traduction in native (French) language was warmly wished in order to facilitate the diffusion of the information. The pathologic threshold for the diagnosis of thrombotic microangiopathic anemia (TMA) (>1%) remained questionable. For half of the biologists, the new fragmented red blood cell (FRC) parameter recently provided by two manufacturers of automated blood cell counters was still doubtful for routine use.
CONCLUSIONS: This survey assessed the impact of international \'guidelines\' on the French biological community. The will to implement validated recommendations was strong, reflecting the awareness of the biologists to standardize the laboratory investigations.

The schistocytes are fragmented red blood cells mainly observed in the setting of hemolytic anemias and particularly among the thrombotic microangiopathies. The presence of schistocytes is an important criterion for the diagnosis of mechanical anemias, though the identification of these cells remains problematic. As a high variability of the morphologic identification criteria of the schistocytes among morphologists has been observed, some guidelines have been proposed after workshops (French and Italian groups). The International council for standardization in hematology published a consensus in November, 2011. The French group of cellular hematology (GFHC) aimed to recover the opinion of French biologists directly confronted to schistocytes measurements. 169 out 500 (34%) answered 10 questions dealing with the identification and measurements of schistocytes as proposed by the ICSH guidelines. A consensus was reached for the urgent need of guidelines documents, moreover in the current background of the European accreditation NF EN ISO 15189 rules. A traduction in native (French) language as warmly wished in order to facilitate the diffusion of the information. New fragmented red cell parameter recently provided by 2 manufacturers of automated blood cell counters remained doubtfull for routine use for half of the biologists.

In our studies of microcytosis, the complete blood count (CBC) of 82,830 randomly selected patients was analysed. Of these 34.3% showed microcytosis, and 5.5% were not anaemic. Emphasis was given to study the extent, causes and patterns of non-iron deficient microcytosis. Haematological data was adequate to differentiate iron deficient (ID) from non-iron deficient (NID) patients with microcytosis in 285 subjects. Of these 21.4% were found to be NID. A majority (73.8%) had showed a form of haemoglobinopathy, the commonest being beta-thalassaemia minor (60.7%). Of non-invasive investigations, mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), red cell size distribution width (RDW), anisocytosis in blood smears, serum iron (SI) and haemoglobin electrophoresis, the parameter which separated ID from NID patients most effectively was haemoglobin electrophoresis. It showed an abnormal pattern in 82% of NID subjects and normal pattern in 96.4% ID subjects. In the 18% of the NID subjects with a normal pattern, raised serum iron levels characterized 11% additional subjects with NID.