Microangiopathic hemolytic anemia differential diagnosis

Associate Editor(s)-in-Chief: Mydah Sajid, MD [1]

Microangiopathic hemolytic anemia must be differentiated from following diseases^[1]:


Disease	Findings
Pseudo-TTP (Vitamin B12 deficiency)	Patients have neurological symptoms like numbness, ataxic gait and tingling along with macrocytic anemia. There is a reduced level of reticulocytes, with elevated levels of Lactate dehydrogenase (i.e. greater than 5000 U/L), methylmalonate, and homocysteine.
Pregnancy induced fatty liver	Patients presents with right upper quadrant or epigastric abdominal pain, nausea and vomiting. On laboratory work-up, there is hypoglycemia along with deranged liver function tests. There is elevated levels of bilirubin, alanine aminotransferase, aspartate aminotransferase, reduced antithrombin III and coagulation factors level^[2].
Disseminated intravascular coagulation	Can occur in sepsis, and different malignancies like prostate cancer, Acute promyelocytic leukemia and Gastric cancer, there in increased consumption of fibrin. On laboratory work-up, there is reduced fibrinogen level, Auer rod in Acute promyelocytic leukemia and leukoerythroblastic picture, with nucleated [[red blood cell]s, poikilocytosis, left shift of white blood cells. In sepsis, there is elevation of procalcitonin along with positive blood culture and reduced levels of coagulation factors.
Endocarditis	Patients have multi-system involvement presenting with fever, sepsis, polyartharalgia, Janeway lesion, Osler’s node, and a new-onset or changed heart murmur. It is diagnosed clinically by Duke’s criteria. It is confirmed by blood culture and trans-esophageal echocardiography.
Evan’s syndrome	Immune mediated thrombocytopenia and autoimmune hemolytic anemia. Coombs test positive. On peripheral blood smear, there are no schistocytes.
Antiphospholipid syndrome	Women have a history of artery thrombi and deep venous thrombosis in lower extremeties, recurrent abortion, stroke and headache. These patients have prolonged activated partial thromboplastin time and positive serology for anti-cardiolipin antibodies.
Malaria, Babesiosis	Patients presents with periodic spikes of high-grade fever with rigors, chills, nausea, vomiting, fatigue, myalgia and malaise. The intra-cellular parasite are identified on special stained peripheral blood smear.
Viral Infections	In specific viral diseases like Dengue hemorrhagic fever, hantavirus and filoviridae, there is significant thrombocytopenia. Patients have a recent history of travel. There are no signs of hemolysis on laboratory workup.

References

↑ Bommer M, Wölfle-Guter M, Bohl S, Kuchenbauer F (2018). “The Differential Diagnosis and Treatment of Thrombotic Microangiopathies”. Dtsch Arztebl Int. 115 (19): 327–334. doi:10.3238/arztebl.2018.0327. PMC 5997890. PMID 29875054.
↑ Ko H, Yoshida EM (2006). “Acute fatty liver of pregnancy”. Can J Gastroenterol. 20 (1): 25–30. doi:10.1155/2006/638131. PMC 2538964. PMID 16432556.

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[pmid29875054-1] Bommer M, Wölfle-Guter M, Bohl S, Kuchenbauer F (2018). “The Differential Diagnosis and Treatment of Thrombotic Microangiopathies”. Dtsch Arztebl Int. 115 (19): 327–334. doi:10.3238/arztebl.2018.0327. PMC 5997890. PMID 29875054.

[pmid16432556-2] Ko H, Yoshida EM (2006). “Acute fatty liver of pregnancy”. Can J Gastroenterol. 20 (1): 25–30. doi:10.1155/2006/638131. PMC 2538964. PMID 16432556.

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