Approach to Thrombotic Microangiopathy (TMA) - Differential Diagnosis and Management Algorithm



Suspected TMA: Unexplained thrombocytopenia + MAHA ±AKI

Initial labs: CBC, BMP, Reticulocytes, smear, Haptoglobin, LDH, Urine hemoglobin/hemosiderin, Hepatic function panel, Direct antiglobulin test, PT/aPTT

MAHA likely:

 • Smear: schistocytes > 1%

 • ↑ Reticulocyte index

 • ↑ LDH

 • ↑ Total/indirect bilirubin

 • ↓ Haptoglobin

 • ↑ Urine hemoglobin/ hemosiderin

 • PT/aPTT normal

 • DAT negative



Matthew Ho, MD PhD @MatthewHoMD



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