Transplant-associated thrombotic microangiopathy: Diagnostic challenges and management strategies

Mohamed Elemary; Waleed Sabry; Jerard Seghatchian; Hadi Goubran

doi:10.1016/j.transci.2019.04.022

Transplant-associated thrombotic microangiopathy: Diagnostic challenges and management strategies

Transfus Apher Sci. 2019 Jun;58(3):347-350. doi: 10.1016/j.transci.2019.04.022. Epub 2019 May 1.

Authors

Mohamed Elemary¹, Waleed Sabry², Jerard Seghatchian³, Hadi Goubran²

Affiliations

¹ Saskatoon Cancer Centre and College of Medicine, University of Saskatchewan, Saskatoon, Canada. Electronic address: Mohamed.elemary@saskcancer.ca.
² Saskatoon Cancer Centre and College of Medicine, University of Saskatchewan, Saskatoon, Canada.
³ International Consultancy in Blood Components Quality/Safety Improvement, Audit/Inspection and DDR Strategies, London, UK.

PMID: 31097308
DOI: 10.1016/j.transci.2019.04.022

Abstract

Transplant-associated thrombotic microangiopathy (TA-TMA) is one of the early endothelial complications post Hematopoietic Stem Cell Transplant (HSCT). Several mechanisms during HSCT can contribute to systemic capillary endothelial damage which can lead to TA-TMA among other complications as capillary leak syndrome or engraftment syndrome. Early diagnosis of TA-TMA contributes a challenge due to overlapping clinical manifestations and the absence of specific diagnostic criteria. Incidence is greatly variable between 1-76% according to risk factors of patients and the definition used to confirm the diagnosis. The mortality rates in patients who develop severe TA-TMA are in excess of 80%. Early treatment improves the outcome. This review outlines the diagnostic challenges and therapeutic options for TA-TMA.

Keywords: Diagnosis; Management; TA-TMA; Transplant-associated thrombotic microangiopathy.

Publication types

Review

MeSH terms

Allografts
Capillary Leak Syndrome* / diagnosis
Capillary Leak Syndrome* / etiology
Capillary Leak Syndrome* / metabolism
Capillary Leak Syndrome* / therapy
Hematopoietic Stem Cell Transplantation*
Humans
Thrombotic Microangiopathies* / diagnosis
Thrombotic Microangiopathies* / etiology
Thrombotic Microangiopathies* / metabolism
Thrombotic Microangiopathies* / therapy