[Secondary thrombotic microangiopathies]

Rev Med Interne. 2017 Nov;38(11):731-736. doi: 10.1016/j.revmed.2017.06.025. Epub 2017 Sep 8.
[Article in French]


Thrombotic microangiopathies (TMA) are termed secondary when associated to a specific context favouring their occurrence. They encompass mainly TMA associated with pregnancy, allogeneic hematopoietic stem cell transplantation, cancer, drugs, or HIV infection. Secondary TMA represent a heterogeneous group of diseases which clinical presentation largely depends on the associated context. It is therefore mandatory to recognize these conditions since they have a significant impact in TMA management and prognosis. A successful management still represents a challenge in secondary TMA. Significant progresses have been made in the understanding of pregnancy-associated TMA, allowing an improvement of prognosis; on the opposite, other forms of secondary TMA such as hematopoietic stem cell transplantation-associated TMA or TMA associated with chemotherapy remain of dismal prognosis. A better understanding of pathophysiology in these forms of TMA, in association with a more empirical approach through the use of new therapeutic agents that can also help in the understanding on new mechanisms a posteriori, should improve their prognosis. The preliminary encouraging results reported with complement blockers in this field could represent a convincing example.

Keywords: Allogeneic hematopoietic stem cell transplantation; Allogreffe; Cancer; Chemotherapy; Chimiothérapie; Eculizumab; HIV infection; Microangiopathie thrombotique; Thrombotic microangiopathy; VIH; Éculizumab.

Publication types

  • Review

MeSH terms

  • Allografts
  • Drug-Related Side Effects and Adverse Reactions / complications
  • Drug-Related Side Effects and Adverse Reactions / epidemiology
  • Female
  • HIV Infections / complications
  • HIV Infections / epidemiology
  • Hematopoietic Stem Cell Transplantation / adverse effects
  • Humans
  • Neoplasms / complications
  • Neoplasms / epidemiology
  • Pregnancy
  • Pregnancy Complications, Cardiovascular / epidemiology
  • Pregnancy Complications, Cardiovascular / therapy
  • Thrombotic Microangiopathies / epidemiology
  • Thrombotic Microangiopathies / etiology*
  • Thrombotic Microangiopathies / pathology
  • Thrombotic Microangiopathies / therapy*