Treatment Approach for Thrombotic Microangiopathy (TMA)

Diagnosis and Classification

• The European Society of Cardiology recommends key diagnostic findings for TMA, including schistocytes on peripheral blood smear, elevated LDH, unmeasurable haptoglobin, and evidence of organ damage 1, 2

Diagnostic Workup

• The Kidney International journal suggests immediate testing for ADAMTS13 activity and inhibitors to distinguish TTP from other forms of TMA 3, 4
• The Journal of Clinical Oncology recommends blood smear examination for schistocytes and laboratory evaluation including CBC, LDH, haptoglobin, renal function, and coagulation studies 5, 6

Treatment Algorithm Based on TMA Subtype

• For suspected TTP, the Kidney International journal recommends immediate plasma exchange, high-dose glucocorticoids, and rituximab 4, 5, 6
• For malignant hypertension-associated TMA, the European Heart Journal suggests aggressive blood pressure control as the primary intervention 1, 2, 7

Special Considerations

• The Journal of Clinical Oncology recommends urgent intervention, as delay in diagnosis and treatment significantly increases mortality 5, 6
• The Kidney International journal suggests that pregnant patients with a history of TMA should continue hydroxychloroquine and start low-dose aspirin before 16 weeks gestation 4