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 …