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What the Internist Should Know about Thrombotic Microangiopathies

International Journal of Clinical Medicine 2019年第12期10卷 651-661页

作者： marjan alidoost Attiya Haroon Varsha Gupta Arif Asif Mohammad A. Hossain Department of Medicine JSUMC Neptune NJ USA

Thrombotic microangiopathy (TMA) is a group of diseases that are life-threatening and can lead to end organ damage (EOD) due to ischemia caused by microthrombi in capillaries and arterioles. TMAs can affect any organ system but usually affect the kidney, intestines, and nervous system. The triad of TMA is Coombs-negative hemolytic anemia with schistocytes seen on peripheral smear, thrombocytopenia (platelets under 150,000 or a decrease of 25% or more from baseline), and evidence of ischemic EOD. Primary TMAs include Thrombotic Thrombocytopenic Purpura (TTP), Hemolytic Uremic Syndrome (HUS) and atypical HUS (aHUS). Pathophysiologically, all of these diseases are caused by aggregation of von Willebrand Factor (vWF) multimers, via different mechanisms, which eventually leads to thrombus formation. TTP and aHUS benefit from plasma exchange (PEX), whereas HUS is treated symptomatically. Urgent recognition with timely treatment is crucial to managing these potentially life-threatening conditions.

关键词： TMA aHUS HUS TTP

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Post-traumatic thrombotic microangiopathy: What trauma surgeons need to know?

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Chinese Journal of Traumatology 2021年第2期24卷 69-74页

作者： Mohammad A.Hossain Nasim Ahmed Varsha Gupta Ravneet Bajwa marjan alidoost Arif Asif Tushar Vachharajani Department of Medicine Hackensack Meridian Health Jersey Shore University Medical CenterNeptuneNJ07753USA Department of Surgery Division of Trauma SurgeryHackensack Meridian Health Jersey Shore University Medical CenterNeptuneNJ07753USA Global Nephrology Glickman Urological&Kidney InstituteCleveland ClinicClevelandOH44103USA

Thrombotic microangiopathy(TMA)is characterized by systemic microvascular thrombosis,target organ injury,anemia and *** thrombocytopenic purpura,atypical hemolytic uremic syndrome and Shiga toxin E-coli-related hemolytic uremic syndrome are the three common forms of ***,TMA is encountered during pregnancy/postpartum period,malignant hypertension,systemic infections,malignancies,autoimmune disorders,***,the patients presenting with trauma have been reported to suffer from *** carries a high morbidity and mortality,and demands a prompt recognition and early intervention to limit the target organ *** trauma surgeons are the first line of defense for patients presenting with trauma,the prompt recognition of TMA for these experts is critically *** treatment of post-traumatic TMA can help improve the patient outcomes,if the diagnosis is made *** treatment of TMA is also different from acute blood loss anemia namely in that plasmapheresis is recommended rather than platelet *** article familiarizes trauma surgeons with TMA encountered in the context of ***,it provides a simplified approach to establishing the diagnosis of *** trauma patients can require multiple transfusions,the development of disseminated intravascular coagulation must be ***,the article also provides different features of disseminated intravascular coagulation and ***,the article suggests practical points that can be readily applied to the management of these patients.

关键词： Trauma Microangiopathy Complement amplifying condition

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