Microangiopathic hemolytic anemia: Difference between revisions
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== | ==Background== | ||
'''Microangiopathic hemolytic anemia (MAHA)''' = variety of conditions that result in damaged endothelium of small vessels causing platelet aggregation and fibrin deposition which leads to shearing forces within these small vessels causing an intravascular fragmentation hemolysis | '''Microangiopathic hemolytic anemia (MAHA)''' = variety of conditions that result in damaged endothelium of small vessels causing platelet aggregation and fibrin deposition which leads to shearing forces within these small vessels causing an intravascular fragmentation hemolysis | ||
==Diagnosis== | ==Diagnosis== | ||
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*[[TTP]]/[[HUS]] = '''normal''' PT/INR/PTT/FDPs/D-dimer/fibrinogen<ref name="guidelines"></ref> | *[[TTP]]/[[HUS]] = '''normal''' PT/INR/PTT/FDPs/D-dimer/fibrinogen<ref name="guidelines"></ref> | ||
==Management== | |||
==See Also== | ==See Also== | ||
Revision as of 05:44, 6 May 2015
Background
Microangiopathic hemolytic anemia (MAHA) = variety of conditions that result in damaged endothelium of small vessels causing platelet aggregation and fibrin deposition which leads to shearing forces within these small vessels causing an intravascular fragmentation hemolysis
Diagnosis
- Clinical features + heme labs with red blood cell fragments or schistocytes.[1]
- May have bleeding and thrombosis
Differential Diagnosis
- Most common causes: DIC, TTP, HUS
- Other medical causes: malignant hypertension, HELLP, Antiphospholipid Syndrome (APS), scleroderma, Paroxysmal Nocturnal Hemoglobinuria (PNH), malignancy, renal allograft rejection, vasculitides like polyarteritis nodosa and Wegener's granulomatosis
- Drugs: chemotherapy; Clopidogrel (Plavix) associated with TTP
- Nonvascular causes: prosthetic valve (more common w/ mechanical, more common at aortic valve), LVAD, TIPS, coil embolization, patched AV shunt, AVM
Work-Up
- Peripheral smear, hemoglobin, platelets, PT/INR, PTT, fibrinogen, FDPs, D-dimer, haptoglobin, LDH, bilirubin
- Schistocytes (aka Helmet cells) secondary to fragmentation hemolysis classic finding on peripheral smear
Lab Findings
- Schistocytes
- High: +/- LDH and unconjugated bilirubin
- Low: Hgb, platelets, +/- haptoglobin
General Rules
Management
See Also
- DIC
- TTP
- HUS
- Malignant hypertension, HELLP, Antiphospholipid Syndrome (APS), Paroxysmal Nocturnal Hemoglobinuria (PNH)
- HIT