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Am J Kidney Dis. 2017 Nov;70(5):715-721. doi: 10.1053/j.ajkd.2017.05.017. Epub 2017 Jul 15.

Thrombotic Microangiopathy: A Multidisciplinary Team Approach.

Author information

1
Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA.
2
Hematology-Oncology Section, Department of Medicine, Boston University School of Medicine, Boston, MA.
3
Department of Medicine, Boston University School of Medicine, Boston, MA.
4
Department of Medicine, Boston University School of Medicine, Boston, MA; Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA.
5
Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA. Electronic address: jean.francis@bmc.org.

Abstract

Thrombotic microangiopathy (TMA) is characterized by the presence of microangiopathic hemolytic anemia and thrombocytopenia along with organ dysfunction, and pathologically, by the presence of microthrombi in multiple microvascular beds. Delays in diagnosis and initiation of therapy are common due to the low incidence, variable presentation, and poor awareness of these diseases, underscoring the need for interdisciplinary approaches to clinical care for TMA. We describe a new approach to improve clinical management via a TMA team that originally stemmed from an Affinity Research Collaborative team focused on thrombosis and hemostasis. The TMA team consists of clinical faculty from different disciplines who together are charged with the responsibility to quickly analyze clinical presentations, guide laboratory testing, and streamline prompt institution of treatment. The TMA team also includes faculty members from a broad range of disciplines collaborating to elucidate the pathogenesis of TMA. To this end, a clinical database and biorepository have been constructed. TMA leaders educate front-line providers from other departments through presentations in various forums across multiple specialties. Facilitated by an Affinity Research Collaborative mechanism, we describe an interdisciplinary team dedicated to improving both clinical care and translational research in TMA.

KEYWORDS:

Thrombotic microangiopathy (TMA); clinical care; complement-mediated hemolytic uremic syndrome (CM-HUS); hematology; multidisciplinary team; nephrology; rare disorder; thrombotic thrombocytopenic purpura (TTP); translational research

PMID:
28720207
DOI:
10.1053/j.ajkd.2017.05.017
[Indexed for MEDLINE]

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