II. Mechanism
- RBCs damaged by injured vessel endothelium
- Results in Schistocyte formation
III. Causes
- Prosthetic Heart Valve
- Recent Coronary Artery Bypass Surgery or ECMO
- Arteriovenous Malformation
- Vasculitis
- Malignant Hypertension
- Eclampsia or HELLP Syndrome
- Renal Graft Rejection
- Giant Hemangioma
- Scleroderma
- Thrombotic Thrombocytopenic Purpura (TTP)
- Hemolytic Uremic Syndrome (HUS)
- Disseminated Intravascular Coagulation (DIC)
- March Hemoglobinuria (Marathon runners)
-
Drug-Induced Thrombotic Microangiopathic Anemia (5% of MAHA causes)
- Most commonly due to Quinine, Cyclosporine, Tacrolimus
IV. Exam
V. Labs
- Peripheral Smear
- Liver Function Tests
- Renal Function Tests
- ProTime (PT)
- Partial Thromboplastin Time (aPTT)
VI. References
- Udden in Goldman (2000) Cecil Medicine. p. 882-4
- Phillips (2018) Am Fam Physician 98(6): 354-61 [PubMed]