title: Pathology Consultation on the Diagnosis and Treatment of Thrombotic Microangiopathies (TMAs).
abstract: OBJECTIVE
  Pathologists specializing in transfusion medicine, apheresis medicine, and/or coagulation are often consulted by clinicians to reach a diagnosis for patients with thrombotic microangiopathy (TMA), so that disease-specific, often life-saving therapy can be initiated as promptly as possible.
  
  
  METHODS
  This article describes how to proceed when treating a patient with TMA. The differential diagnosis is broad and potentially very challenging. Thrombotic thrombocytopenic purpura (TTP), atypical hemolytic uremic syndrome (aHUS), and typical hemolytic uremic syndrome (HUS) are three such TMAs that require timely diagnosis and treatment.
  
  
  RESULTS
  TTP is treated with daily therapeutic plasma exchange (TPE) and commonly with adjunctive immunosuppressive therapy, while aHUS may initially be managed with TPE but is best controlled with eculizumab once a presumptive diagnosis is made. TPE has no proven role in typical HUS, which is most commonly treated with supportive measures only.
  
  
  CONCLUSIONS
  Prompt and accurate diagnosis of TMA subtypes optimizes treatment and improves patient outcomes.
authors.affiliation: From the Department of Pathology, University of Alabama at Birmingham.
authors.forename: Lance A
authors.initials: LA
authors.lastname: Williams
authors.affiliation: From the Department of Pathology, University of Alabama at Birmingham.
authors.forename: Marisa B
authors.initials: MB
authors.lastname: Marques
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D065766:Atypical Hemolytic Uremic Syndrome / Q000175:diagnosis* / Q000628:therapy; D003937:Diagnosis, Differential; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D010951:Plasma Exchange; D049590:Postpartum Period; D011247:Pregnancy; D011697:Purpura, Thrombotic Thrombocytopenic / Q000175:diagnosis* / Q000628:therapy; D012017:Referral and Consultation; D057049:Thrombotic Microangiopathies / Q000175:diagnosis* / Q000628:therapy; D055815:Young Adult
chemical_list: D061067:Antibodies, Monoclonal, Humanized; C481642:eculizumab
keywords: Hemolytic uremic syndrome (HUS); Microangiopathic hemolytic anemia (MAHA); Thrombotic microangiopathy (TMA); Thrombotic thrombocytopenic purpura (TTP)