When TMA Strikes - Every Second Counts

ACT FAST. Rapid Recognition and Diagnosis Reduces the Risk of Kidney Damage and Life-Threatening Complications.1,2

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See the threat and stay ahead of the TMA storm
The symptoms of TMA are non-specific (e.g., neurological impairment, organ system failure, GI manifestations).
Recognizing them early helps ensure your patients stay ahead of the storm.1,2 
Patients with TMA present with the following clinical triad of laboratory signs and symptoms: 
And one or more of the following:
TMA may be more common than you think. Screen for TMA, espeically in the presence of the following triggers:
aInvestigated the presence of TMA in a large and well-characterized cohort of 199 patients with malignant hypertension of different etiologies.
bClinical and renal histopathological data of 148 patients with biopsy-proven lupus nephritis were retrospectively analyzed.
cReview of 188 patients with kidney or kidney-pancreas transplants who were treated between 1994 and 1996, analyzing 50 patients who had graft biopsies: 26
with TMA and 24 with no TMA.
dReview of previously accumulated information and research. 
Patients with TMA are at risk for dialysis, kidney failure, and death7

TMAs represent a medical emergency with high morbidity and a high mortality. And with that, rapid assessment, establishing [a] diagnosis, and the initiation of appropriate treatment are critical.

Dr. Christoph Licht, MD, FRCPC, FASN
University of Toronto
The Hospital for Sick Children
Toronto, Ontario
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 aPrior to plasma exchange/plasma infusion (PE/PI) for an accurate baseline reading, though it may be conducted afterward.
If TMA persists on specific treatment of the associated condition, consider a diagnosis of aHUS
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Download aHUS Disease Awareness Tool
Adult Patient in ICU Pediatric Patient in ICU

It’s important to [involve specialist colleagues] as early as possible when you’re going through the differential [diagnosis], particularly, when you see these hematologic abnormalities, and the microangiopathic hemolytic anemia signature. This is because at least in adults, these patients can deteriorate very rapidly, and early involvement of the right team members able to administer the right treatments is critical.

Dr. Eddy Lang, MDCM
University of Calgary
Alberta Health Services
Calgary, Alberta 
Download the TMA Order Set for guidance on initial lab investigations, diagnostics, and supportive management. 
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ADAMTS13, a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13; aHUS, atypical hemolytic uremic syndrome; DIC, disseminated intravascular coagulation; eGFR, estimated glomerular filtration rate; ER, emergency room; ICU, intensive care unit; TMA, thrombotic microangiopathy; STEC-HUS, shiga toxin E. coli related hemolytic uremic syndrome; TTP, thrombotic thrombocytopenic purpura.
Azoulay E, et al. Chest. 2017;152(2):424-434.  Laurence J, et al. Clin Adv Hematol Oncol. 2016;14 Suppl 11(11):2-15.  Cavero T, et al. Nephrol Dial Transplant. 2023;38(5):1217-1226.  Song D, et al. Arthritis Res Ther. 2013;15(1):R12.  Zarifian A, et al. Kidney Int. 1999;55(6):2457-2466.  Blake-Haskins JA, Lechleider RJ, Kreitman RJ. Clin Cancer Res. 2011;17(18):5858-5866.  Caprioli J, et al. Blood. 2006;108(4):1267-1279.