image by: USFHealth

HWN Suggests

MAHA, TTP, HUS, DIC... Oh My! Understanding Microangiopathic Hemolytic Anemias

Thrombotic Thrombocytopenic Purpura (TTP), Hemolytic Uremic Syndrome (HUS), and Disseminated Intravascular Coagulation (DIC). These conditions should be added to the “Can’t Miss List”... However, understanding and recognizing these conditions may make the difference between life and death for a patient, further emphasizing the need to translate this word salad into clinical knowledge that can be applied...

read full article

Featured

 Thrombotic microangiopathies (including TTP, ST-HUS, and C-HUS)

MAHA (revealed by hemolytic anemia plus schistocytes) – erythrocytes rip open as they are forced through small blood vessels which are partially occluded.

 Thrombotic microangiopathies: An illustrated review

The thrombotic microangiopathies (TMAs) are a heterogenous group of disorders with distinct pathophysiologies that cause occlusive microvascular or macrovascular thrombosis, and are characterized by microangiopathic hemolytic anemia, thrombocytopenia, and/or end‐organ ischemia. TMAs are associated with significant morbidity and mortality, and data on the management of certain TMAs are often lacking.

Articles of Interest

Hemolytic Anemias: Rare but Important Diagnosis in the Emergency Department

In general, MAHA refers to conditions where red blood cells become fragmented as they pass through platelet-fibrin rich microthrombi that accumulate in capillaries and arterioles.. The pathophysiology of the development of these clots is complicated and there are many underlying contributors to the development of MAHA including bacterial toxins, radiation treatments, autoimmune diseases, and medications. Due to intravascular platelet aggregation and deposition, varying degrees of thrombocytopenia will be present along with the hemolytic anemia.

How I treat microangiopathic hemolytic anemia in patients with cancer

Microangiopathic hemolytic anemia (MAHA) refers to a subgroup of hemolytic anemia where there is fragmentation and hemolysis due to damage of erythrocytes in the small blood vessels. It is characterized by the presence of red cell fragments or schistocytes on blood film review. Further evidence of hemolysis may include a reticulocytosis, raised lactate dehydrogenase (LDH), low or absent haptoglobin, and increased unconjugated bilirubin levels. MAHA may occur in isolation due to a direct effect on red blood cells, such as trauma due to mechanical heart valves or infections (eg, malaria or march hemoglobinuria), but it is more commonly seen as part of a thrombotic microangiopathy (TMA).

Recent Advances in the Management of Microangiopathic Hemolytic Anemias (MAHA): A Narrative Review

Microangiopathic hemolytic anemia (MAHA) is a term used to describe non-immune hemolysis induced by intravascular RBC fragmentation caused by substances in the tiny blood arteries that generate schistocytes in the peripheral circulation. Microvasculature abnormalities, such as small arterioles and capillaries, are usually involved. Furthermore, MAHA can also be brought on by intravascular devices like a prosthetic heart valve or assistive technologies.

The challenge of microangiopathic hemolytic anemia

Microangiopathic hemolytic anemia (MAHA) is a Coomb's-negative hemolytic anemia characterized by red cell fragmentation (schistocytes). Thrombotic microangiopathy anemia, including thrombotic thrombocytopenia and hemolytic-uremic syndrome, malignant hypertension, preeclampsia are among the most common causes.

Thrombotic microangiopathies: a general approach to diagnosis and management

Microangiopathic hemolytic anemia is the hallmark of thrombotic microangiopathy. It is a process of red blood cell destruction within the microvasculature accompanied by thrombocytopenia due to platelet activation and consumption. Thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS) are primary forms of thrombotic microangiopathies.