Causes of red blood cell fragmentation

Condition	Mechanism(s)
Primary TMAs*	Intravascular RBC shearing and platelet microthrombi
TTP	Ultralarge VWF multimers and platelet microthrombi
HUS	Damaged endothelium and platelet microthrombi
Complement-mediated TMA	Damaged endothelium and platelet microthrombi
Systemic conditions	Intravascular RBC shearing and platelet/fibrin thrombi
DIC	Intravascular platelet/fibrin thrombi
HELLP and preeclampsia	Damaged endothelium and platelet microthrombi
Malignancy	Shearing within intravascular tumor deposits
Malignant hypertension	Damaged endothelium and platelet microthrombi
Scleroderma renal crisis	Damaged endothelium and platelet microthrombi
APS	Intravascular thrombi
Isolated intravascular sites of hemolysis	Intravascular RBC shearing by turbulence and/or mechanical trauma in the isolated site
Kasabach-Merritt syndrome	Platelet trapping and localized intravascular coagulation within the angioma
TIPS	Shear stress and mechanical trauma in the shunt
Malfunctioning cardiac valves or cardiac assist devices	Shear stress and mechanical trauma across the valve or assist device
March hemoglobinuria, extreme running, bongo drumming	Repetitive trauma as blood passes through vessels in feet or hands

Refer to UpToDate content on hemolytic anemias due to red blood cell fragmentation and on the individual disorders for further details.

DIC: disseminated intravascular coagulation; HELLP: hemolysis, elevated liver function tests, and low platelets; APS: antiphospholipid syndrome; TIPS: transjugular intrahepatic portosystemic shunt; VWF: Von Willebrand factor; TMA: thrombotic microangiopathy; RBC: red blood cell.
* Primary TMAs include thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), complement-mediated TMA, drug-induced TMA, coagulation-mediated TMA, and metabolism-mediated TMA.

Courtesy of Stanley L. Schrier, MD

Graphic 105380 Version 1.0

خرید پکیج

Causes of red blood cell fragmentation