Initial diagnostic workup in patients suspected of TA-TMA
| Test . | Indication . | Rationale . |
|---|---|---|
| CBC/diff, reticulocytes, BMP, LFT, total/direct bilirubin, LDH, haptoglobin | All patients | Confirm hemolysis, rule out red cell aplasia or aplastic anemia |
| Blood smear (serial) | All patients | Confirm presence & persistence of schistocytosis |
| DAT; IAT (ask for agglutination strength) | All patients | Rule out autoimmune or alloimmune hemolytic anemia |
| DIC panel (PT/PTT/INR, D-dimer, fibrinogen) | All patients | Rule out DIC |
| Infectious workup | All patients | Rule out infection/sepsis |
| Vitamin B12 | All patients | Rule out cobalamin deficiency-related pseudo-TMA |
| Urinalysis; spot rUPCR | All patients | Seek early renal organ damage (proteinuria) |
| sC5b9 assay | Suspected TA-TMA | Prognostic biomarker for TA-TMA |
| ADAMTS13; antinuclear antibody; lupus anticoagulant; anticardiolipin; beta-2-glycoprotein | Autoimmune history | Rule out TTP & other autoimmune causes (rare to occur first-time post-transplant without prior history) |
| Stool culture for Shiga toxin; gut biopsy | New diarrhea | Rule out ST-HUS |
| Bone marrow biopsy | Inappropriate hematopoiesis or circulating blasts | Rule out relapse of pre-transplant disease or graft failure |
| Kidney biopsy | New kidney injury | Confirm diagnosis of TMA on biopsy |
| Test . | Indication . | Rationale . |
|---|---|---|
| CBC/diff, reticulocytes, BMP, LFT, total/direct bilirubin, LDH, haptoglobin | All patients | Confirm hemolysis, rule out red cell aplasia or aplastic anemia |
| Blood smear (serial) | All patients | Confirm presence & persistence of schistocytosis |
| DAT; IAT (ask for agglutination strength) | All patients | Rule out autoimmune or alloimmune hemolytic anemia |
| DIC panel (PT/PTT/INR, D-dimer, fibrinogen) | All patients | Rule out DIC |
| Infectious workup | All patients | Rule out infection/sepsis |
| Vitamin B12 | All patients | Rule out cobalamin deficiency-related pseudo-TMA |
| Urinalysis; spot rUPCR | All patients | Seek early renal organ damage (proteinuria) |
| sC5b9 assay | Suspected TA-TMA | Prognostic biomarker for TA-TMA |
| ADAMTS13; antinuclear antibody; lupus anticoagulant; anticardiolipin; beta-2-glycoprotein | Autoimmune history | Rule out TTP & other autoimmune causes (rare to occur first-time post-transplant without prior history) |
| Stool culture for Shiga toxin; gut biopsy | New diarrhea | Rule out ST-HUS |
| Bone marrow biopsy | Inappropriate hematopoiesis or circulating blasts | Rule out relapse of pre-transplant disease or graft failure |
| Kidney biopsy | New kidney injury | Confirm diagnosis of TMA on biopsy |
BMP, basic metabolic panel; CBC/diff, complete blood count with differential; DAT, direct antiglobulin test (direct Coombs); DIC, disseminated intravascular coagulation; IAT, indirect antiglobulin test; INR, international normalized ratio; LDH, lactate dehydrogenase; LFT, liver function tests; PT, prothrombin time; PTT, partial thromboplastin time; rUPCR, random urine protein creatinine ratio; ST-HUS, Shiga toxin hemolytic uremic syndrome; TTP, thrombotic thrombocytopenic purpura.