An 86-year-old man returned to the UK from Spain with symptoms suggestive of gastrointestinal bleeding. He was found have an acute kidney injury and thrombocytopenia. Further investigations identified presence a microangiopathic hemolytic anemia, supporting diagnosis thrombotic microangiopathy. Differentials included atypical uremic syndrome secondary Thrombotic thrombocytopenic purpura (TTP) S...

This review article covers the diverse pathophysiological pathways that can lead to microangiopathic hemolytic anemia and a procoagulant state with or without damage to the kidneys and other organs.

Thrombotic microangiopathy results from thrombotic occlusion of the microvasculature leading to fragmentation of red blood cells, profound thrombocytopenia, and a microangiopathic hemolytic anemia with elevation of lactate dehydrogenase and negative direct Coomb's test. This constellation of clinical and laboratory findings is not due to one disease entity; rather, it represents a variety of un...