Post-traumatic thrombotic microangiopathy: What trauma surgeons need to know?

Abstract

Thrombotic microangiopathy (TMA) is characterized by systemic microvascular thrombosis, target organ injury, anemia and thrombocytopenia. Thrombotic thrombocytopenic purpura, atypical hemolytic uremic syndrome and Shiga toxin E-coli-related hemolytic uremic syndrome are the three common forms of TMAs. Traditionally, TMA is encountered during pregnancy/postpartum period, malignant hypertension, systemic infections, malignancies, autoimmune disorders, etc. Recently, the patients presenting with trauma have been reported to suffer from TMA. TMA carries a high morbidity and mortality, and demands a prompt recognition and early intervention to limit the target organ injury. Because trauma surgeons are the first line of defense for patients presenting with trauma, the prompt recognition of TMA for these experts is critically important. Early treatment of post-traumatic TMA can help improve the patient outcomes, if the diagnosis is made early. The treatment of TMA is also different from acute blood loss anemia namely in that plasmapheresis is recommended rather than platelet transfusion. This article familiarizes trauma surgeons with TMA encountered in the context of trauma. Besides, it provides a simplified approach to establishing the diagnosis of TMA. Because trauma patients can require multiple transfusions, the development of disseminated intravascular coagulation must be considered. Therefore, the article also provides different features of disseminated intravascular coagulation and TMA. Finally, the article suggests practical points that can be readily applied to the management of these patients.

Thrombotic microangiopathy after traumatic brain injury: A case report and review of the literature

“…Trauma, however, is not included in the classic etiology in many reviews and has yet only recently been recognized as a potential mechanism of secondary TMA. 4 We could only identify three case reports handling TMA following major trauma [5][6][7] The first case described TMA following blunt abdominal liver injury in a 23 yearold male who suffered a motor vehicle accident. The diagnosis was only made after 21 days and following treatment for sepsis and start of hemodialysis, 6 which is longer and more complicated than in our case.…”

“…These major causes of TMA, however, are unlikely as precipitating TMA in our case as described further. Trauma, however, is not included in the classic etiology in many reviews and has yet only recently been recognized as a potential mechanism of secondary TMA 4 …”

“…Trauma, however, is not included in the classic etiology in many reviews and has yet only recently been recognized as a potential mechanism of secondary TMA. 4 …”

“…Classically thrombotic thrombocytopenic purpura (TTP), atypical hemolytic uremia syndrome (HUS), and Shiga toxin E‐coli related (STEC) HUS are well‐known subtypes of this disorder. Recently, trauma has been suggested as a trigger for initiating TMA 4 …”

“…Recently, trauma has been suggested as a trigger for initiating TMA. 4 Progression of TIC to TMA, however, has not been described and only a few case reports [5][6][7] and one case series 8 describe TMA following trauma. We report an additional patient with TMA following an isolated traumatic brain injury.…”