Microangiopathic hemolytic anemia

(MAHA; NEJM 2014;371:654)

• Intra-arteriolar fibrin damages RBCs → acquired intravascular hemolysis

• Etiologies:

  • hemolytic-uremic syndrome (HUS),
  • thrombotic thrombocytopenic purpura (TTP),
  • disseminated intravascular coagulation (DIC),
  • malignancy,
  • malignant HTN,
  • eclampsia/HELLP,
  • mech. cardiac valves,
  • infected vascular prostheses

• Diagnosis:

  • schistocytes
  • ± ↓ plts
  • ± ↑ PT in DIC, ↑ Cr in HUS,
  • NOTE: ↑ LFTs in HELLP

• Rx: see “DIC” section in “Coagulopathies” and “TTP/HUS” sections in “Platelet Disorders”