Etiologies and Outcomes of Thrombotic Microangiopathies

Thrombotic microangiopathy (TMA) presents a significant diagnostic challenge due to its diverse clinical manifestations and the varied medical departments—ranging from critical care to hematology—where patients are treated. A comprehensive nine-year study of 564 consecutive patients at the Tours University Hospital reveals that primary TMAs, such as atypical HUS, account for only 6% of cases, while secondary TMAs are far more prevalent. Pregnancy-associated TMA is the most frequent secondary cause, though half of these patients present with multiple concurrent triggers, including infections and drug reactions. Despite the presence of universal markers like schistocytes and high LDH, the inconsistency of diagnostic workups across 19 different hospital departments highlights a need for standardized care. The severity of the condition is underscored by high morbidity rates, with 15% of patients requiring dialysis, 11% experiencing major cardiovascular events, and 10% resulting in inpatient mortality.