Microangiopathic Anemia

Aka: Microangiopathic Anemia, Microangiopathic Hemolytic Anemia, Fragmentation Hemolysis, MAHA

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II. Mechanism

  1. RBCs damaged by injured vessel endothelium
  2. Results in Schistocyte formation

III. Causes

  1. Prosthetic Heart Valve
  2. Recent Coronary Artery Bypass Surgery or ECMO
  3. Arteriovenous Malformation
  4. Vasculitis
  5. Malignant Hypertension
  6. Eclampsia or HELLP Syndrome
  7. Renal Graft Rejection
  8. Giant Hemangioma
  9. Scleroderma
  10. Thrombotic Thrombocytopenic Purpura (TTP)
  11. Hemolytic Uremic Syndrome (HUS)
  12. Disseminated Intravascular Coagulation (DIC)
  13. March Hemoglobinuria (Marathon runners)
  14. Drug-Induced Thrombotic Microangiopathic Anemia (5% of MAHA causes)
    1. Most commonly due to Quinine, Cyclosporine, Tacrolimus

IV. Exam

  1. Blood Pressure

V. Labs

  1. Peripheral Smear
    1. Schistocytes
  2. Liver Function Tests
  3. Renal Function Tests
  4. ProTime (PT)
  5. Partial Thromboplastin Time (aPTT)

VI. References

  1. Udden in Goldman (2000) Cecil Medicine. p. 882-4
  2. Phillips (2018) Am Fam Physician 98(6): 354-61 [PubMed]

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