II. Definitions
- Thrombotic Microangiopathy
- Life-threatening conditions causing Microangiopathic Hemolytic Anemia, Thrombocytopenia and thrombosis
III. Causes
- Heparin Induced Thrombocytopenia
- Disseminated Intravascular Coagulation
-
Drug-Induced Thrombotic Microangiopathic Anemia
- See Drug-Induced Thrombotic Microangiopathic Anemia for a list of medication causes
- Presents with fever, chills, gastrointestinal symptoms, renal dysfunction and microvascular thrombosis
- May be indistinguishable on presentation with TTP
-
Antiphospholipid Syndrome
- History of Recurrent Pregnancy Loss, VTE, CVA
- Longterm Aspirin for primary prevention (Anticoagulation for secondary prevention)
-
Thrombotic Thrombocytopenic Purpura (TTP)
- Presents with fever, Renal Failure, microvascular thrombosis (esp. CNS with Headaches)
-
Hemolytic Uremic Syndrome
- Presents with Abdominal Pain, bloody Diarrhea and Renal Failure (esp. children)
IV. Labs
- Complete Blood Count
- Serum Creatinine Increased (Acute Kidney Injury)
- Lactate Dehydrogenase Increased
- D-Dimer elevated and Fibriniogen Decreased
- ADAMTS13 Acitivity decreased
- Thrombotic Thrombocytopenic Purpura
- Drug-Induced Thrombotic Microangiopathic Anemia (mildly decreased or normal)
- Antiphospholipid Antibody (Anticardiolipin Antibody, Lupus Anticoagulant, anti-beta-Glycoprotein)
V. Management
- See Thrombocytopenia
- Emergent Hematology Consultation
- Hospitalization and Supportive Care
- High mortality without prompt evaluation and management
- Withdraw all suspected causative medications
- Plasmapheresis or Plasma exchange
- Complement-mediated Thrombotic Thrombocytopenic Purpura
- Drug-Induced Thrombotic Microangiopathic Anemia in which TTP cannot be excluded