A study of clinical and pathological correlation in cases of thrombotic microangiopathy

Background : Thrombotic Microangiopathy (TMA) is defined as a lesion comprising vessel wall thickening (mainly arterioles and capillaries), intra luminal thrombosis and partial or complete obstruction of the vessel lumina.Thrombotic Microangiopathies are a group of conditions characterized by micro vascular thrombosis leading to thrombocytopenia, hemolytic anemia and red cell fragmentation.Objective : Retrospective analysis of clinical and pathological features of patients with thrombotic microangiopthy.Methods :Twenty eight patients who were diagnosed histopathologically as cases of thrombotic microangiopthy in Gandhi Hospital over a period of 5 years from August 2005 to July 2010 were included in this study. Renal profile including ultrasound study were carried out in all cases and repeated every month. Results: Of the total twenty eight patients 15 were males (54%), 13 were females (46%). Aetiology consists of diarrhea associated HUS (36%), idiopathic (18%), post transplant HUS (14%), post partum HUS (14%), malignant hypertension (11%) and SLE with APLA (7%) leading to thrombotic microangiopthy. Clinical presentations were oligoanuria in 89%, anasarca in 85%, hypertension in 85%, jaundice in 39%, diarrhea in 36%, bleeding diathesis in 25%, seizures in 18% and gross hematuria in 7%. Anemia and thrombocytopenia were universal features. Conclusion: This study shows glomerular changes were predominant in children with thrombotic microangiopthy. Adults with thrombotic microangiopthy have glomerular as well as vascular changes. An attempt has been made to study renal survival and Dialysis dependency in the patients studied by having follow up of one year