Syndromes of Thrombotic Microangiopathy

Med Clin North Am. 2017 Mar;101(2):395-415. doi: 10.1016/j.mcna.2016.09.010. Epub 2016 Dec 27.

Abstract

Thrombotic thrombocytopenia purpura (TTP) and the hemolytic uremic syndrome (HUS) are rare thrombotic microangiopathies that can be rapidly fatal. Although the acquired versions of TTP and HUS are generally highest on this broad differential, multiple rarer entities can produce a clinical picture similar to TTP/HUS, including microangiopathic hemolysis, renal failure, and neurologic compromise. More recent analysis has discovered a host of genetic factors that can produce microangiopathic hemolytic syndromes. This article discusses the current understanding of thrombotic microangiopathy and outlines the pathophysiology and causative agents associated with each distinct syndrome as well as the most accepted treatments.

Keywords: Atypical hemolytic uremic syndrome (aHUS); Hemolytic uremic syndrome (HUS); Microangiopathic hemolytic anemia (MAHA); Pregnancy induced microangiopathic hemolytic anemia; Thrombotic thrombocytopenic purpura (TTP); Transplant induced microangiopathic hemolytic anemia.

Publication types

  • Review

MeSH terms

  • ADAMTS13 Protein / metabolism
  • Adjuvants, Immunologic / therapeutic use
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Hemolytic-Uremic Syndrome / physiopathology*
  • Hemolytic-Uremic Syndrome / therapy
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Purpura, Thrombotic Thrombocytopenic / physiopathology*
  • Purpura, Thrombotic Thrombocytopenic / therapy
  • Thrombotic Microangiopathies / etiology
  • Thrombotic Microangiopathies / genetics
  • Thrombotic Microangiopathies / physiopathology*
  • Thrombotic Microangiopathies / therapy

Substances

  • Adjuvants, Immunologic
  • Antibodies, Monoclonal, Humanized
  • Immunosuppressive Agents
  • eculizumab
  • ADAMTS13 Protein