title: Thrombotic microangiopathic syndromes associated with drugs, HIV infection, hematopoietic stem cell transplantation and cancer.
abstract: Thrombotic microangiopathy (TMA) has multiple etiologies. In the four disorders described in this review, the primary organ involved is the kidney. Drug-associated TMA can be an acute, immune-mediated disorder or the result of gradual, dose-dependent toxicity. TMA may occur in patients with advanced HIV infection, possibly mediated by angio-invasive infections. TMA following allogeneic hematopoietic stem cell transplantation may also be caused by drug toxicity; the pathogenesis may involve inhibition of vascular endothelial cell growth factor in renal podocytes. Malignancies of many types with systemic microvascular involvement may cause TMA. Recognition that these syndromes may mimic TTP is important to provide appropriate management and to avoid the inappropriate use of plasma exchange treatment.
authors.affiliation: The University of Oklahoma Health Sciences Center, College of Public Health, Department of Biostatistics and Epidemiology, P.O. Box 73190, Oklahoma City, United States. james-george@ouhsc.edu
authors.forename: James N
authors.initials: JN
authors.lastname: George
authors.forename: Deirdra R
authors.initials: DR
authors.lastname: Terrell
authors.forename: Sara K
authors.initials: SK
authors.lastname: Vesely
authors.forename: Johanna A
authors.initials: JA
authors.lastname: Kremer Hovinga
authors.forename: Bernhard
authors.initials: B
authors.lastname: Lämmle
mesh_terms: D064420:Drug-Related Side Effects and Adverse Reactions; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy; D010951:Plasma Exchange / Q000379:methods; D012042:Registries; D013577:Syndrome; D013921:Thrombocytopenia / Q000139:chemically induced / Q000175:diagnosis; D057049:Thrombotic Microangiopathies / Q000139:chemically induced / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy