A Fatal Case of Thrombotic Microangiopathy Without Schistocytosis and Absent Biochemical Markers of Hemolysis |
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| Institution: | 1. Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, New York;2. Division of Internal Medicine, Saint Barnabas Medical Center, Livingston, New Jersey;1. Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Sidney Kimmel School of Medicine; and Jane & Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pennsylvania;2. Department of Radiology, Division of Thoracic Radiology, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania;1. Department of Cardiology, Affiliated Hospital of Beihua University, Jilin City, China;2. Department of Gaoxin, China Institute of Standardization, Beijing, China;3. Department of Physiology, Basic Medical College of Beihua University, Jilin City, China;1. Department of Radiation Oncology and Medical Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, China;2. Department of Gastrointestinal Medical Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;3. Department of Pathology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;1. Department of Epidemiology and Biostatistics, Zhejiang Chinese Medical University, Hangzhou, China;2. Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China;3. Department of Epidemiology and Biostatistics, Zhejiang University School of Public Health, Hangzhou, China;1. Section of Health Systems Research and Policy, Medical University of South Carolina, Charleston, South Carolina;2. Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina;3. Charleston Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson VA Medical Center, Charleston, South Carolina;4. Department of Neurology, Medical University of South Carolina, Charleston, South Carolina;1. Department of Pulmonary Function Test, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China;2. Department of Respiratory Medicine, Wuhu Hospital of Traditional Chinese Medicine, Wuhu, China;3. Department of Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China |
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| Abstract: | Thrombotic microangiopathy (TMA) is characterized by microangiopathic hemolytic anemia with thrombocytopenia. In addition to the primary TMA syndromes, microangiopathic hemolytic anemia with thrombocytopenia can be seen in many systemic diseases. Transplant associated TMA (TA-TMA) affects patients following stem cell or solid organ transplant. A 48-year-old male who underwent autologous stem cell transplant for nonsecretory multiple myeloma was admitted to our hospital with worsening anemia, thrombocytopenia, renal dysfunction and hepatosplenomegaly. Initial blood work revealed rare schistocytes and normal lactate dehydrogenase and haptoglobin levels. He underwent an extensive workup looking for an infectious, inflammatory or malignant etiology but a definitive diagnosis could not be reached. Over his prolonged stay at the hospital, he suffered from multiorgan failure and eventually passed away. An autopsy revealed TMA involving all clinically affected organ systems and was deemed to be the cause of his demise. The absence of typical blood work suggestive of hemolysis does not rule out a diagnosis of TA-TMA. Knowledge of this rare disease entity will help physicians identify and treat this life-threatening condition early and effectively. |
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