Causes of microangiopathic hemolytic anaemia (MAHA)
- Hemolytic uremic syndrome (HUS)
- Thrombotic thrombocytopenic purpura (TTP)
- Accelerated hypertension
- Septicaemia
- Vasculitides
- Connective tissue diseases
- Malignancy ( Approx 80% are Mucinous adenocarcinoma of either stomach, breast or lungs)
- Burns
- Prosthetic valve-induced hemolysis
- Drugs (ciclosporin, mitomycin)
Additional:
● MAHA is also known as fragmentation hemolytic anaemia
●RBC fragmentation & hemolysis occur when red cells are forced at high shear stress through the partial vascular occlusion or over abnormal vascular surfaces
●MAHA produces a characteristic blood picture of anaemia, red cell fragments (known as "Split" red cells or schistocytes), thrombocytopenia and increased reticulocytes
● Considerable quantities of LDH are released into the blood from the traumatised RBCs
● Small vessels fibrin deposition and thrombosis, resulting from MAHA may lead to renal damage and oliguric renal failure
●Bleeding and bruising are commonly seen. In pure MAHA, the blood clotting mechanism is usually normal but if often coexists with DIC where clotting is impaired.
☆ MAHA is found in association with some cancers
Mechanism of occurrence of MAHA in malignancies: Two mechanisms
1. DIC with intravenous occlusion (often partial) of small vessels by platelet-fibrin thrombi
2. Intravascular tumour emboli
Source:
• Rapid review of clinical medicine for MRCP part 2, 2nd Edition, by Sanjay Sharma and Rashmi Kaushal Q:152
• Williams Hematology 9th Edition; page 801 & 803
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