We need you! Join our contributor community and become a WikEM editor through our open and transparent promotion process.
Microangiopathic hemolytic anemia
From WikEM
(Redirected from Microangiopathic Hemolytic Anemia (MAHA))
Contents
Background
- Abbreviation: MAHA
- A 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
Clinical Features
- Clinical features + heme labs with red blood cell fragments or schistocytes.[1]
- May have bleeding and thrombosis
Differential Diagnosis
Microangiopathic Hemolytic Anemia (MAHA)
- Disseminated Intravascular Coagulation (DIC)
- Thrombotic Thrombocytopenic Purpura (TTP)
- Hemolytic Uremic Syndrome (HUS)
- HELLP syndrome
- Heparin-Induced Thrombocytopenia (HIT)
- Hereditary spherocytosis
- Paroxysmal nocturnal hemoglobinuria
- Malignant hypertension
- Antiphospholipid syndrome
- Scleroderma
- Antiphospholipid Syndrome (APS)
- Paroxysmal Nocturnal Hemoglobinuria (PNH)
- Other medical causes: 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 with mechanical, more common at aortic valve), LVAD, TIPS, coil embolization, patched AV shunt, AVM
Evaluation
- 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
Disposition
See Also
References
- ↑ 1.0 1.1 1.2 Scully. Marie et al. Guidelines on the diagnosis and management of thrombotic thrombocytopenic purpura and other thrombotic microangiopathies. Br J Haematol. 2012 Aug;158(3):323-35. PDF
