Search
microangiopathic hemolytic anemia
Etiology:
1) thrombotic thrombocytopenic purpura (TTP)
2) hemolytic uremic syndrome (HUS)
3) disseminated intravascular coagulation (DIC)
4) intravascular prosthetic devices
- prosthetic heart valve
5) malignant hypertension
6) preeclampsia, eclampsia & HELLP syndrome [3]
7) pulmonary hypertension
8) renal disease
a) acute glomerulonephritis
b) acute renal failure
c) renal allograft rejection
d) acute radiation nephropathy
9) autoimmune disease, vasculitis & connective tissue diseases
a) scleroderma renal crisis [3]
b) systemic lupus erythematosus
c) Wegener's granulomatosis
d) polyarteritis nodosa
e) antiphospholipid antibody syndrome [3]
10) carcinomas
a) metastatic mucin-secreting adenocarcinoma [2]
b) small gastric carcinomas
c) carcinomatosis
11) hemangiomas
12) cardiac neoplasms [1]
13) rupture chordae tendinae
14) Kasabach-Merritt syndrome
15) infections
a) viral infections (epecially HIV)
b) bacterial infections
16) drugs:
- mytomycin C, cyclosporine
- calcineurin inhibitors
17) organ transplantation [3]
a) bone marrow transplant (allogeneic > autologous)
b) solid organ transplantation rejection [3]
c) total body irradiation
d) cyclosporine
Pathology:
- erythrocyte fragmentation
Laboratory:
1) direct antiglobulin test is negative
2) peripheral smear -> schistocytes, helmet cells
3) platelet count -> thrombocytopenia is common
Special laboratory:
- echocardiogram if mechanical heart valve [3]
Differential diagnosis:
- thrombotic microangiopathy
Management:
- directed towards underlying disease [3]
Related
thrombotic microangiopathy
General
hemolytic anemia
References
- Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed)
Lippincott-Raven, Philadelphia, 1998, pg 414
- Schiller G, in: UCLA Intensive Course in Geriatric Medicine &
Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18.
American College of Physicians, Philadelphia 2012, 2015, 2018