Sonata Jodele, MD
While complex, criteria for diagnosing transplant-associated thrombotic microangiopathy (TA-TMA) following hematopoietic stem cell transplantation (HSCT) should be closely followed and should begin with screening, according to a presentation during the 2019 European Society for Blood and Marrow Transplantation Annual Meeting.
These criteria changed somewhat until the current guidelines were accepted, which comprise:
- LDH above normal for age,
- Schistocytes on peripheral blood smear,
- De novo thrombocytopenia/required platelet transfusions,
- De novo anemia or required red blood cell transfusions
- Hypertension >99% for age, 140/90, or antihypertensive therapy
- Proteinuria ≥30 mg/dL (2 measurements) or urine protein creatinine ratio ≥2 mg/mg,
- Terminal complement activation elevated above normal (≥244 ng/mL).
Jodele proposed that diagnosis be based upon presence of 4 of the above 7 laboratory and clinical markers and noted that proteinuria and complement activation are high-risk markers for TMA. She commented that ADAMTS13 activity may be reduced in TMA but remains >10%, elevated haptoglobin is a poor prognostic marker, and serum creatinine is a late occurring marker that is only useful if elevated, especially in children.
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