BMJ  2007;335:206-207 (28 July), doi:10.1136/bmj.39279.588507.80

Practice

Commentary: Nephrologist

Royal Free Hospital, London NW3 2PG

The first 150 words of the full text of this article appear below.

A clotting screen is essential to differentiate between causes of microangiopathic haemolytic anaemia. These can be either thrombotic microangiopathy or disseminated intravascular coagulation, possibly related to an obstetric calamity, sepsis, malignancy, or acute inflammation such as acute pancreatitis. In this case, normal clotting studies support the diagnosis of thrombotic microangiopathy.

The box lists the causes of thrombotic microangiopathy. In each situation, end organ injury will be exacerbated by hypertension. For this patient, initial management must focus on urgent treatment of her accelerated hypertension, which may even switch off the thrombotic microangiopathy. She needs immediate admission to a unit with facilities for invasive monitoring. Intravenous furosemide and nitrate infusion are appropriate if clinical signs of fluid overload are present. In acute renal failure, the response to furosemide is usually poor, and haemofiltration (or haemodialysis) should be started early. However, circulating volume can be reduced in accelerated hypertension and medical management is . . . [Full text of this article]

Causes of thrombotic microangiopathy

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BMJ 2007 335: 205-206. [Extract] [Full Text] [PDF]