From the Guidelines
Thrombotic Microangiopathy (TMA) workup requires a highly specialized approach, involving specific testing and potential treatment with plasma exchange, which should be done at centers experienced in TMA diagnosis and treatment 1.
Initial Evaluation
Initial steps include:
- A thorough medical history and physical examination to identify potential underlying causes of TMA
- Laboratory tests, such as a complete blood count, blood chemistry, and coagulation studies to assess for thrombocytopenia, anemia, and other signs of TMA 1
- Imaging studies may be ordered to evaluate for potential complications of TMA, such as renal or neurological involvement
Specialized Testing
Specialized testing, including:
- ADAMTS13 activity assay to diagnose thrombotic thrombocytopenic purpura (TTP), a subtype of TMA 1
- Complement studies to evaluate for atypical hemolytic uremic syndrome (aHUS), another subtype of TMA
- Genetic testing to identify potential genetic causes of TMA
Management
Management of TMA may involve:
- Plasma exchange, which is a critical component of TTP treatment and may be considered in other forms of TMA 1
- Medications, such as eculizumab, to inhibit the complement system in aHUS
- Supportive care, including blood transfusions and dialysis, as needed
Referral to a Specialist
Given the complexity and specialized nature of TMA diagnosis and treatment, it is essential to refer patients to a nephrologist or hematologist with experience in TMA management 1.
From the Research
Thrombotic Microangiopathy (TMA) Work-up
There are no research papers provided that directly discuss the work-up for Thrombotic Microangiopathy (TMA). The studies provided focus on transient monocular blindness and its association with vascular complications, rather than TMA.
Relevant Findings from Transient Monocular Blindness Studies
- The studies 2, 3, 4, 5, 6 discuss the importance of identifying patients with retinal ischemia and vasculitis as the cause of transient monocular vision loss.
- Characteristics of transient monocular blindness, such as involvement of only the peripheral part of the visual field, constricting onset of loss of vision, and downward onset of loss of vision, are associated with subsequent vascular events 3.
- Atherosclerotic lesions of the internal carotid artery are associated with certain features of transient monocular blindness, including altitudinal onset or disappearance of symptoms, and a duration between 1 and 10 minutes 4.
- Age has a major impact on the diagnosis of ischemia, and timely and appropriate history, examination, diagnostic testing, and treatment can be vision- or life-saving 5.
- Transient monocular blindness is considered a transient ischemic attack originating in the carotid arteries, and must be managed the same as transient ischemic attack involving the brain, in order to prevent a subsequent stroke 6.
Limitations
The provided studies do not discuss the work-up for Thrombotic Microangiopathy (TMA), and therefore do not provide relevant information for answering this question.