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Drug-induced thrombotic microangiopathy

James N George, MD
Adam Cuker, MD, MS
Section Editor
Lawrence LK Leung, MD
Deputy Editor
Jennifer S Tirnauer, MD


Thrombotic microangiopathies (TMAs) are potentially life-threatening conditions caused by small-vessel platelet microthrombi. Patients have the characteristic clinical features of microangiopathic hemolytic anemia (MAHA) and thrombocytopenia, and they may have acute kidney injury (AKI), neurologic abnormalities, and/or cardiac ischemia.

Drug-induced TMA (DITMA) is especially challenging to diagnose because specific laboratory tests to identify a drug etiology may not be available, and the role of a potentially implicated drug or other ingested substance may not be clear. Some of the implicated substances are illegal and may not be volunteered by the patient, and quinine exposure often is not recorded in the medication history when quinine is obtained without a prescription or ingested in a beverage such as tonic water. The principal treatment of DITMA is withdrawing the suspected drug. However, management of a patient with suspected DITMA may be challenging because the clinical diagnostic criteria for DITMA overlap with other primary TMAs (eg, thrombotic thrombocytopenic purpura [TTP], complement-mediated TMA) that do require specific interventions (plasma exchange [PEX] and anticomplement therapy, respectively).

Here we discuss our approach to the evaluation and management of a patient with a suspected DITMA.

Separate topic reviews present an overview of our approach to the evaluation of a patient with unexplained MAHA and thrombocytopenia as well as related TMAs including TTP:

(See "Approach to the patient with suspected TTP, HUS, or other thrombotic microangiopathy (TMA)".)

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Literature review current through: Nov 2017. | This topic last updated: Oct 26, 2017.
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