Thrombotic Microangiopathy Syndromes

Part of the Cancer Treatment and Research book series (CTAR, volume 148)

Thrombotic microangiopathy (TMA) describes a spectrum of clinical syndromes all characterized by microvascular platelet thrombi with resultant thrombocytopenia and microangiopathic hemolytic anemia (MAHA). Organ dysfunction can commonly include renal failure or neurologic abnormalities such as mental status changes, confusion, or seizures. The most common TMA is idiopathic thrombotic thrombocytopenic purpura (TTP). Hemolytic-uremic syndrome (HUS) is commonly used to describe a TMA with associated renal insufficiency, and typically without neurologic sequelae. The distinction between TTP and HUS is not always clear, and therefore HUS can be reserved for the distinct TMA syndrome associated with bloody diarrhea due to shiga-toxin producing Eschericia coli 0157.H7. There are a variety of other conditions which can also be associated with a TMA including pregnancy, autoimmune diseases, cancers, drug-associated TMA and TMA associated with hematopoietic stem cell or solid organ transplantation. The diagnosis of TTP should be reserved for idiopathic cases, while the term TMA should be utilized for the many secondary causes of the syndrome.


Hematopoietic Stem Cell Transplant Thrombotic Thrombocytopenic Purpura Allogeneic Hematopoietic Stem Cell Transplant Thrombotic Microangiopathy Autologous Hematopoietic Stem Cell Transplant 


  1. 1.
    Moake JL, Rudy CK, Troll JH, et al. Unusually large plasma factor VIII: von Willebrand factor multimers in chronic relapsing thrombotic thrombocytopenic purpura. N Engl J Med 1982;307(23):1432–5.PubMedCrossRefGoogle Scholar
  2. 2.
    Furlan M, Robles R, Lamie B. Partial purification and characterization of a protease from human plasma cleaving von Willebrand factor to fragments produced by in vivo proteolysis. Blood 1996;87(10):4223–34.PubMedGoogle Scholar
  3. 3.
    Tsai HM. Physiologic cleavage of von Willebrand factor by a plasma protease is dependent on its conformation and requires calcium ion. Blood 1996;87(10):4235–44.PubMedGoogle Scholar
  4. 4.
    Levy GG, Nichols WC, Lian EC, et al. Mutations in a member of the ADAMTS gene family cause thrombotic thrombocytopenic purpura. Nature 2001;413(6855):488–94.PubMedCrossRefGoogle Scholar
  5. 5.
    Furlan M, Robles R, Galbusera M, et al. von Willebrand factor-cleaving protease in thrombotic thrombocytopenic purpura and the hemolytic-uremic syndrome. N Engl J Med 1998;339(22):1578–84.PubMedCrossRefGoogle Scholar
  6. 6.
    Tsai HM, Lian EC. Antibodies to von Willebrand factor-cleaving protease in acute thrombotic thrombocytopenic purpura. N Engl J Med 1998;339(22):1585–94.PubMedCrossRefGoogle Scholar
  7. 7.
    Vesely SK, George JN, Lammle B, et al. ADAMTS13 activity in thrombotic thrombocytopenic purpura-hemolytic uremic syndrome: relation to presenting features and clinical outcomes in a prospective cohort of 142 patients. Blood 2003;102(1):60–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Veyradier A, Obert B, Houllier A, Meyer D, Girma JP. Specific von Willebrand factor-cleaving protease in thrombotic microangiopathies: a study of 111 cases. Blood 2001;98(6):1765–72.PubMedCrossRefGoogle Scholar
  9. 9.
    Zheng XL, Kaufman RM, Goodnough LT, Sadler JE. Effect of plasma exchange on plasma ADAMTS13 metalloprotease activity, inhibitor level, and clinical outcome in patients with idiopathic and nonidiopathic thrombotic thrombocytopenic purpura. Blood 2004;103(11):4043–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Gordon LI, Kwaan HC. Thrombotic microangiopathy manifesting as thrombotic thrombocytopenic purpura/hemolytic uremic syndrome in the cancer patient. Semin Thromb Hemost 1999;25(2):217–21.PubMedCrossRefGoogle Scholar
  11. 11.
    Lesesne JB, Rothschild N, Erickson B, et al. Cancer-associated hemolytic-uremic syndrome: analysis of 85 cases from a national registry. J Clin Oncol 1989;7(6):781–9.PubMedGoogle Scholar
  12. 12.
    Francis KK, Kalyanam N, Terrell DR, Vesely SK, George JN. Disseminated malignancy misdiagnosed as thrombotic thrombocytopenic purpura: A report of 10 patients and a systematic review of published cases. Oncologist 2007;12(1):11–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Kressel BR, Ryan KP, Duong AT, Berenberg J, Schein PS. Microangiopathic hemolytic anemia, thrombocytopenia, and renal failure in patients treated for adenocarcinoma. Cancer 1981;48(8):1738–45.PubMedCrossRefGoogle Scholar
  14. 14.
    Hamilton CA, Kao JM, Coutre SE, Teng NN. Acute postoperative thrombotic thrombocytopenic purpura following hysterectomy and lymphadenectomy for endometrial cancer. Gynecol Oncol 2007;106(2):423–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Cataland SR, Jin M, Smith E, Stanek M, Wu HM. Full evaluation of an acquired case of thrombotic thrombocytopenic purpura following the surgical resection of glioblastoma multiforme. J Thromb Haemost 2006;4(12):2733–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Robson MG, Abbs IC. Thrombotic thrombocytopenic purpura following hemicolectomy for colonic carcinoma. Nephrol Dial Transplant 1997;12(1):198–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Raife TJ, Lager DJ. Chronic thrombotic microangiopathy associated with antineoplastic therapy with minimal hematologic effects. Mayo Clin Proc 2002;77(4):323–8.Google Scholar
  18. 18.
    Pinckard JK, Wick MR. Tumor-related thrombotic pulmonary microangiopathy: review of pathologic findings and pathophysiologic mechanisms. Ann Diagn Pathol 2000;4(3):154–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Chinen K, Kazumoto T, Ohkura Y, Matsubara O, Tsuchiya E. Pulmonary tumor thrombotic microangiopathy caused by a gastric carcinoma expressing vascular endothelial growth factor and tissue factor. Pathol Int 2005;55(1):27–31.PubMedCrossRefGoogle Scholar
  20. 20.
    Franchini M, Montagnana M, Targher G, Lippi G. Reduced von Willebrand factor-cleaving protease levels in secondary thrombotic microangiopathies and other diseases. Semin Thromb Hemost 2007;33(8):787–97.PubMedCrossRefGoogle Scholar
  21. 21.
    Fontana S, Gerritsen HE, Kremer Hovinga J, Furlan M, Lammle B. Microangiopathic haemolytic anaemia in metastasizing malignant tumours is not associated with a severe deficiency of the von Willebrand factor-cleaving protease. Br J Haematol 2001;113(1):100–2.PubMedCrossRefGoogle Scholar
  22. 22.
    Blot E, Decaudin D, Veyradier A, Bardier A, Zagame OL, Pouillart P. Cancer-related thrombotic microangiopathy secondary to Von Willebrand factor-cleaving protease deficiency. Thromb Res 2002;106(2):127–30.PubMedCrossRefGoogle Scholar
  23. 23.
    Studt JD, Kremer Hovinga JA, Alberio L, Bianchi V, Lammle B. Von Willebrand factor-cleaving protease (ADAMTS-13) activity in thrombotic microangiopathies: diagnostic experience 2001/2002 of a single research laboratory. Swiss Med Wkly 2003;133(23–24):325–32.PubMedGoogle Scholar
  24. 24.
    Rieger M, Mannucci PM, Kremer Hovinga JA, et al. ADAMTS13 autoantibodies in patients with thrombotic microangiopathies and other immunomediated diseases. Blood 2005;106(4):1262–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Sugimoto T, Saigo K, Shin T, et al. Von Willebrand factor-cleaving protease activity remains at the intermediate level in thrombotic thrombocytopenic purpura. Acta Haematol 2005;113(3):198–203.PubMedCrossRefGoogle Scholar
  26. 26.
    Werner TL, Agarwal N, Carney HM, Rodgers GM. Management of cancer-associated thrombotic microangiopathy: what is the right approach? Am J Hematol 2007;82(4):295–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Morishita T, Matsumoto M, Honoki K, Yoshida A, Takakura Y, Fujimura Y. Successful treatment of primitive neuroectodermal tumor-associated microangiopathy with multiple bone metastases. Jpn J Clin Oncol 2007;37(1):66–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Lammle B, Kremer Hovinga JA, Alberio L. Thrombotic thrombocytopenic purpura. J Thromb Haemost 2005;3(8):1663–75.PubMedCrossRefGoogle Scholar
  29. 29.
    Bianchi V, Robles R, Alberio L, Furlan M, Lammle B. Von Willebrand factor-cleaving protease (ADAMTS13) in thrombocytopenic disorders: a severely deficient activity is specific for thrombotic thrombocytopenic purpura. Blood 2002;100(2):710–3.PubMedCrossRefGoogle Scholar
  30. 30.
    Oleksowicz L, Bhagwati N, DeLeon-Fernandez M. Deficient activity of von Willebrand's factor-cleaving protease in patients with disseminated malignancies. Cancer Res 1999;59(9):2244–50.PubMedGoogle Scholar
  31. 31.
    Mannucci PM, Karimi M, Mosalaei A, Canciani MT, Peyvandi F. Patients with localized and disseminated tumors have reduced but measurable levels of ADAMTS-13 (von Willebrand factor cleaving protease). Haematologica 2003;88(4):454–8.PubMedGoogle Scholar
  32. 32.
    Koo BH, Oh D, Chung SY, et al. Deficiency of von Willebrand factor-cleaving protease activity in the plasma of malignant patients. Thromb Res 2002;105(6):471–6.PubMedCrossRefGoogle Scholar
  33. 33.
    Bohm M, Gerlach R, Beecken WD, Scheuer T, Stier-Bruck I, Scharrer I. ADAMTS-13 activity in patients with brain and prostate tumors is mildly reduced, but not correlated to stage of malignancy and metastasis. Thromb Res 2003;111(1–2):33–7.PubMedCrossRefGoogle Scholar
  34. 34.
    Moake JL. Thrombotic microangiopathies. N Engl J Med 2002;347(8):589–600.PubMedCrossRefGoogle Scholar
  35. 35.
    Snyder HW Jr, Mittelman A, Oral A, et al. Treatment of cancer chemotherapy-associated thrombotic thrombocytopenic purpura/hemolytic uremic syndrome by protein A immunoadsorption of plasma. Cancer 1993;71(5):1882–92.PubMedCrossRefGoogle Scholar
  36. 36.
    Qu L, Kiss JE. Thrombotic microangiopathy in transplantation and malignancy. Semin Thromb Hemost 2005;31(6):691–9.PubMedCrossRefGoogle Scholar
  37. 37.
    Oleksowicz L, Dutcher JP, Deleon-Fernandez M, Paietta E, Etkind P. Human breast carcinoma cells synthesize a protein immunorelated to platelet glycoprotein-Ib alpha with different functional properties. J Lab Clin Med 1997;129(3):337–46.PubMedCrossRefGoogle Scholar
  38. 38.
    Jimenez JJ, Jy W, Mauro LM, Horstman LL, Soderland C, Ahn YS. Endothelial microparticles released in thrombotic thrombocytopenic purpura express von Willebrand factor and markers of endothelial activation. Br J Haematol 2003;123(5): 896–902.PubMedCrossRefGoogle Scholar
  39. 39.
    Rock GA, Shumak KH, Buskard NA, et al. Comparison of plasma exchange with plasma infusion in the treatment of thrombotic thrombocytopenic purpura. Canadian Apheresis Study Group. N Engl J Med 1991;325(6):393–7.PubMedCrossRefGoogle Scholar
  40. 40.
    Rizvi MA, Vesely SK, George JN, et al. Complications of plasma exchange in 71 consecutive patients treated for clinically suspected thrombotic thrombocytopenic purpura-hemolytic-uremic syndrome. Transfusion 2000;40(8):896–901.PubMedCrossRefGoogle Scholar
  41. 41.
    Howard MA, Williams LA, Terrell DR, Duvall D, Vesely SK, George JN. Complications of plasma exchange in patients treated for clinically suspected thrombotic thrombocytopenic purpura-hemolytic uremic syndrome. Transfusion 2006;46(1):154–6.PubMedCrossRefGoogle Scholar
  42. 42.
    Zupancic M, Shah PC, Shah-Khan F. Successful splenectomy in cancer-associated TTP. Am J Hematol 2007;82(3):250–1.PubMedCrossRefGoogle Scholar
  43. 43.
    Kwaan HC, Gordon LI. Thrombotic microangiopathy in the cancer patient. Acta Haematol 2001;106(1–2):52–6.PubMedCrossRefGoogle Scholar
  44. 44.
    Medina PJ, Sipols JM, George JN. Drug-associated thrombotic thrombocytopenic purpura-hemolytic uremic syndrome. Curr Opin Hematol 2001;8(5):286–93.PubMedCrossRefGoogle Scholar
  45. 45.
    Ravandi-Kashani F, Cortes J, Talpaz M, Kantarjian HM. Thrombotic microangiopathy associated with interferon therapy for patients with chronic myelogenous leukemia: coincidence or true side effect? Cancer 1999;85(12):2583–8.PubMedCrossRefGoogle Scholar
  46. 46.
    Al-Zahrani H, Gupta V, Minden MD, Messner HA, Lipton JH. Vascular events associated with alpha interferon therapy. Leuk Lymphoma 2003;44(3):471–5.PubMedCrossRefGoogle Scholar
  47. 47.
    Humphreys BD, Sharman JP, Henderson JM, et al. Gemcitabine-associated thrombotic microangiopathy. Cancer 2004;100(12):2664–70.PubMedCrossRefGoogle Scholar
  48. 48.
    Eremina V, Jefferson JA, Kowalewska J, et al. VEGF inhibition and renal thrombotic microangiopathy. N Engl J Med 2008;358(11):1129–36.PubMedCrossRefGoogle Scholar
  49. 49.
    Valavaara R, Nordman E. Renal complications of mitomycin C therapy with special reference to the total dose. Cancer 1985;55(1):47–50.PubMedCrossRefGoogle Scholar
  50. 50.
    Cantrell JE Jr, Phillips TM, Schein PS. Carcinoma-associated hemolytic-uremic syndrome: a complication of mitomycin C chemotherapy. J Clin Oncol 1985;3(5):723–34.PubMedGoogle Scholar
  51. 51.
    Proia AD, Harden EA, Silberman HR. Mitomycin-induced hemolytic-uremic syndrome. Arch Pathol Lab Med 1984;108(12):959–62.PubMedGoogle Scholar
  52. 52.
    Doll DC, Weiss RB, Issell BF. Mitomycin: ten years after approval for marketing. J Clin Oncol 1985;3(2):276–86.PubMedGoogle Scholar
  53. 53.
    Nagaya S, Wada H, Oka K, et al. Hemostatic abnormalities and increased vascular endothelial cell markers in patients with red cell fragmentation syndrome induced by mitomycin C. Am J Hematol 1995;50(4):237–43.PubMedCrossRefGoogle Scholar
  54. 54.
    Fung MC, Storniolo AM, Nguyen B, Arning M, Brookfield W, Vigil J. A review of hemolytic uremic syndrome in patients treated with gemcitabine therapy. Cancer 1999;85(9):2023–32.PubMedGoogle Scholar
  55. 55.
    Walter RB, Joerger M, Pestalozzi BC. Gemcitabine-associated hemolytic-uremic syndrome. Am J Kidney Dis 2002;40(4):E16.PubMedCrossRefGoogle Scholar
  56. 56.
    Zupancic M, Shah PC, Shah-Khan F. Gemcitabine-associated thrombotic thrombocytopenic purpura. Lancet Oncol 2007;8(7):634–41.PubMedCrossRefGoogle Scholar
  57. 57.
    Izzedine H, Isnard-Bagnis C, Launay-Vacher V, et al. Gemcitabine-induced thrombotic microangiopathy: a systematic review. Nephrol Dial Transplant 2006;21(11):3038–45.PubMedCrossRefGoogle Scholar
  58. 58.
    Frangie C, Lefaucheur C, Medioni J, Jacquot C, Hill GS, Nochy D. Renal thrombotic microangiopathy caused by anti-VEGF-antibody treatment for metastatic renal-cell carcinoma. Lancet Oncol 2007;8(2):177–8.PubMedCrossRefGoogle Scholar
  59. 59.
    Kamba T, McDonald DM. Mechanisms of adverse effects of anti-VEGF therapy for cancer. Br J Cancer 2007;96(12):1788–95.PubMedCrossRefGoogle Scholar
  60. 60.
    Kilickap S, Abali H, Celik I. Bevacizumab, bleeding, thrombosis, and warfarin. J Clin Oncol 2003;21(18):3542; author reply 3.PubMedCrossRefGoogle Scholar
  61. 61.
    Galesic K, Bozic B, Racic I, Scukanec-Spoljar M. Thrombotic microangiopathy associated with alpha-interferon therapy for chronic myeloid leukaemia. Nephrology (Carlton) 2006;11(1):49–52.CrossRefGoogle Scholar
  62. 62.
    Rachmani R, Avigdor A, Youkla M, et al. Thrombotic thrombocytopenic purpura complicating chronic myelogenous leukemia treated with interferon-alpha. A report of two successfully treated patients. Acta Haematol 1998;100(4):204–6.PubMedCrossRefGoogle Scholar
  63. 63.
    Al Aly Z, Philoctete Ashley JM, Gellens ME, Gonzalez EA. Thrombotic thrombocytopenic purpura in a patient treated with imatinib mesylate: true association or mere coincidence? Am J Kidney Dis 2005;45(4):762–8.PubMedCrossRefGoogle Scholar
  64. 64.
    Baliga RS, Wingo CS. Quinine induced HUS-TTP: an unusual presentation. Am J Med Sci 2003;326(6):378–80.PubMedCrossRefGoogle Scholar
  65. 65.
    George JN, Li X, McMinn JR, Terrell DR, Vesely SK, Selby GB. Thrombotic thrombocytopenic purpura-hemolytic uremic syndrome following allogeneic HPC transplantation: a diagnostic dilemma. Transfusion 2004;44(2):294–304.PubMedCrossRefGoogle Scholar
  66. 66.
    Iacopino P, Pucci G, Arcese W, et al. Severe thrombotic microangiopathy: an infrequent complication of bone marrow transplantation. Gruppo Italiano Trapianto Midollo Osseo (GITMO). Bone Marrow Transplant 1999;24(1):47–51.PubMedCrossRefGoogle Scholar
  67. 67.
    Ho VT, Cutler C, Carter S, et al. Blood and marrow transplant clinical trials network toxicity committee consensus summary: thrombotic microangiopathy after hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2005;11(8):571–5.PubMedCrossRefGoogle Scholar
  68. 68.
    Ruutu T, Barosi G, Benjamin RJ, et al. Diagnostic criteria for hematopoietic stem cell transplant-associated microangiopathy: results of a consensus process by an International Working Group. Haematologica 2007;92(1):95–100.PubMedCrossRefGoogle Scholar
  69. 69.
    Uderzo C, Bonanomi S, Busca A, et al. Risk factors and severe outcome in thrombotic microangiopathy after allogeneic hematopoietic stem cell transplantation. Transplantation 2006;82(5):638–44.PubMedCrossRefGoogle Scholar
  70. 70.
    Nakamae H, Yamane T, Hasegawa T, et al. Risk factor analysis for thrombotic microangiopathy after reduced-intensity or myeloablative allogeneic hematopoietic stem cell transplantation. Am J Hematol 2006;81(7):525–31.PubMedCrossRefGoogle Scholar
  71. 71.
    Daly AS, Hasegawa WS, Lipton JH, Messner HA, Kiss TL. Transplantation-associated thrombotic microangiopathy is associated with transplantation from unrelated donors, acute graft-versus-host disease and venoocclusive disease of the liver. Transfus Apher Sci 2002;27(1):3–12.PubMedCrossRefGoogle Scholar
  72. 72.
    Elliott MA, Nichols WL Jr, Plumhoff EA, et al. Posttransplantation thrombotic thrombocytopenic purpura: a single-center experience and a contemporary review. Mayo Clin Proc 2003;78(4):421–30.Google Scholar
  73. 73.
    Batts ED, Lazarus HM. Diagnosis and treatment of transplantation-associated thrombotic microangiopathy: real progress or are we still waiting? Bone Marrow Transplant 2007;40(8):709–19.PubMedCrossRefGoogle Scholar
  74. 74.
    Peyvandi F, Siboni SM, Lambertenghi Deliliers D, et al. Prospective study on the behaviour of the metalloprotease ADAMTS13 and of von Willebrand factor after bone marrow transplantation. Br J Haematol 2006;134(2):187–95.PubMedCrossRefGoogle Scholar
  75. 75.
    Ruutu T, Hermans J, Niederwieser D, et al. Thrombotic thrombocytopenic purpura after allogeneic stem cell transplantation: a survey of the European Group for Blood and Marrow Transplantation (EBMT). Br J Haematol 2002;118(4):1112–9.PubMedCrossRefGoogle Scholar
  76. 76.
    Teruya J, Styler M, Verde S, Topolsky D, Crilley P. Questionable efficacy of plasma exchange for thrombotic thrombocytopenic purpura after bone marrow transplantation. J Clin Apher 2001;16(4):169–74.PubMedCrossRefGoogle Scholar
  77. 77.
    Palestine AG, Austin HA III, Balow JE, et al. Renal histopathologic alterations in patients treated with cyclosporine for uveitis. N Engl J Med 1986;314(20):1293–8.PubMedCrossRefGoogle Scholar
  78. 78.
    Rodriguez F, Krayenbuhl JC, Harrison WB, et al. Renal biopsy findings and followup of renal function in rheumatoid arthritis patients treated with cyclosporin A. An update from the International Kidney Biopsy Registry. Arthritis Rheum 1996;39(9):1491–8.PubMedCrossRefGoogle Scholar
  79. 79.
    Holler E, Kolb HJ, Hiller E, et al. Microangiopathy in patients on cyclosporine prophylaxis who developed acute graft-versus-host disease after HLA-identical bone marrow transplantation. Blood 1989;73(7):2018–24.PubMedGoogle Scholar
  80. 80.
    Zoja C, Furci L, Ghilardi F, Zilio P, Benigni A, Remuzzi G. Cyclosporin-induced endothelial cell injury. Lab Invest 1986;55(4):455–62.PubMedGoogle Scholar
  81. 81.
    Brown Z, Neild GH. Cyclosporine inhibits prostacyclin production by cultured human endothelial cells. Transplant Proc 1987;19(1 Pt 2):1178–80.Google Scholar
  82. 82.
    Garcia-Maldonado M, Kaufman CE, Comp PC. Decrease in endothelial cell-dependent protein C activation induced by thrombomodulin by treatment with cyclosporine. Transplantation 1991;51(3):701–5.PubMedCrossRefGoogle Scholar
  83. 83.
    Pham PT, Danovitch GM, Wilkinson AH, et al. Inhibitors of ADAMTS13: a potential factor in the cause of thrombotic microangiopathy in a renal allograft recipient. Transplantation 2002;74(8):1077–80.PubMedCrossRefGoogle Scholar
  84. 84.
    Zarifian A, Meleg-Smith S, O'Donovan R, Tesi RJ, Batuman V. Cyclosporine-associated thrombotic microangiopathy in renal allografts. Kidney Int 1999;55(6):2457–66.PubMedCrossRefGoogle Scholar
  85. 85.
    McCauley J, Bronsther O, Fung J, Todo S, Starzl TE. Treatment of cyclosporin-induced haemolytic uraemic syndrome with FK506. Lancet 1989;2(8678–8679):1516.PubMedCrossRefGoogle Scholar
  86. 86.
    Hochstetler LA, Flanigan MJ, Lager DJ. Transplant-associated thrombotic microangiopathy: the role of IgG administration as initial therapy. Am J Kidney Dis 1994;23(3):444–50.PubMedGoogle Scholar
  87. 87.
    Roberts P, Follette D, Allen R, Katznelson S, Albertson T. Cyclosporine A-associated thrombotic thrombocytopenic purpura following lung transplantation. Transplant Proc 1998;30(4):1512–3.Google Scholar
  88. 88.
    Jeejeebhoy FM, Zaltzman JS. Thrombotic microangiopathy in association with cytomegalovirus infection in a renal transplant patient: a new treatment strategy. Transplantation 1998;65(12):1645–8.PubMedCrossRefGoogle Scholar
  89. 89.
    Wiener Y, Nakhleh RE, Lee MW, et al. Prognostic factors and early resumption of cyclosporin A in renal allograft recipients with thrombotic microangiopathy and hemolytic uremic syndrome. Clin Transplant 1997;11(3):157–62.PubMedGoogle Scholar
  90. 90.
    Schmidt RJ, Venkat KK, Dumler F. Hemolytic-uremic syndrome in a renal transplant recipient on FK 506 immunosuppression. Transplant Proc 1991;23(6):3156–7.Google Scholar
  91. 91.
    Trimarchi HM, Truong LD, Brennan S, Gonzalez JM, Suki WN. FK506-associated thrombotic microangiopathy: report of two cases and review of the literature. Transplantation 1999;67(4):539–44.PubMedCrossRefGoogle Scholar
  92. 92.
    Burke GW, Ciancio G, Cirocco R, et al. Microangiopathy in kidney and simultaneous pancreas/kidney recipients treated with tacrolimus: evidence of endothelin and cytokine involvement. Transplantation 1999;68(9):1336–42.PubMedCrossRefGoogle Scholar
  93. 93.
    Randhawa PS, Tsamandas AC, Magnone M, et al. Microvascular changes in renal allografts associated with FK506 (Tacrolimus) therapy. Am J Surg Pathol 1996;20(3):306–12.PubMedCrossRefGoogle Scholar
  94. 94.
    Ramasubbu K, Mullick T, Koo A, et al. Thrombotic microangiopathy and cytomegalovirus in liver transplant recipients: a case-based review. Transpl Infect Dis 2003;5(2):98–103.PubMedCrossRefGoogle Scholar
  95. 95.
    Moutabarrik A, Ishibashi M, Fukunaga M, et al. FK 506 mechanism of nephrotoxicity: stimulatory effect on endothelin secretion by cultured kidney cells and tubular cell toxicity in vitro. Transplant Proc 1991;23(6):3133–6.Google Scholar
  96. 96.
    Nakazawa Y, Hashikura Y, Urata K, et al. Von Willebrand factor–cleaving protease activity in thrombotic microangiopathy after living donor liver transplantation: a case report. Liver Transpl 2003;9(12):1328–33.PubMedCrossRefGoogle Scholar
  97. 97.
    Gharpure VS, Devine SM, Holland HK, Geller RB, O'Toole K, Wingard JR. Thrombotic thrombocytopenic purpura associated with FK506 following bone marrow transplantation. Bone Marrow Transplant 1995;16(5):715–6.PubMedGoogle Scholar
  98. 98.
    Lin CC, King KL, Chao YW, Yang AH, Chang CF, Yang WC. Tacrolimus-associated hemolytic uremic syndrome: a case analysis. J Nephrol 2003;16(4):580–5.PubMedGoogle Scholar
  99. 99.
    Myers JN, Shabshab SF, Burton NA, Nathan SD. Successful use of cyclosporine in a lung transplant recipient with tacrolimus-associated hemolytic uremic syndrome. J Heart Lung Transplant 1999;18(10):1024–6.PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Division of Hematology/OncologyNorthwestern UniversityChicagoUSA

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