thrombotic microangiopathy (TMA)

see also:

• acute kidney injury (AKI) / acute renal failure (ARF)
• microangiopathic hemolytic anemias (MAHAs)

• thrombotic microangiopathy is an uncommon condition which may cause life threatening acute kidney injury (AKI) / acute renal failure (ARF) requiring dialysis

• intravascular haemolysis on the blood film
• raised creatinine level with or without acute kidney injury (AKI) / acute renal failure (ARF)
• thrombocytopenia

• pregnancy-related conditions (HELLP syndrome in pregnancy )
• malignant hypertension
• toxins:
  • bloody diarrhea with shiga toxin
  • direct endothelial toxins (avastin, calcineurin inhibitors)
  • Australian tiger and brown snake bites
• infections
  • COVID-19 coronavirus (2019-nCoV / SARS-CoV-2)
  • E. coli
• malignancies
• scleroderma
• immune-mediated reactions to medications
  • quinine - rare but may occur after one 300mg dose ¹⁾ or after only drinking tonic water ²⁾
  • oxaliplatin
  • gemcitabine
  • sulfasoxazole
• other autoimmune conditions

• thrombotic thrombocytopenic purpura (TTP)
• haemolytic uraemic syndrome (HUS)

• exclude thrombotic thrombocytopenic purpura (TTP) by finding adequate ADAMTS-13 levels
• exclude complement-mediated haemolytic uraemic syndrome (HUS) by finding normal serum C3 levels (although some cases of complement-HUS do have normal serum C3 levels) - this condition may need very expensive life-long Rx with eculizumab
• search for causes of TMA
  • eg. quinine antibodies