Drug-Induced Thrombotic Microangiopathy

Epidemiology

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Etiology

Immune-Mediated

  • Adalimumab (Humira) (see Adalimumab, [[Adalimumab]])
    • Epidemiology: case reports defining an association with thrombotic microangiopathy
  • Ciprofloxacin (Cipro) (see Ciprofloxacin, [[Ciprofloxacin]])
    • Epidemiology: case reports defining an association with thrombotic microangiopathy
  • Famciclovir (Famvir) (see Famciclovir, [[Famciclovir]])
    • Epidemiology: case reports
  • Gemcitabine (Gemzar) (see Gemcitabine, [[Gemcitabine]])
    • Epidemiology: case report of immune-mediated thrombotic microangiopathy (most cases have a toxicity mechanism)
  • Mefloquine (see Mefloquine, [[Mefloquine]])
    • Epidemiology: case reports defining an association with thrombotic microangiopathy
  • Metronidazole (Flagyl) (see Metronidazole, [[Metronidazole]])
    • Epidemiology: case reports defining an association with thrombotic microangiopathy
  • Muromonab-CD3 (Orthoclone OKT3) (see Muromonab-CD3, [[Muromonab-CD3]])
    • Epidemiology: case reports defining an association with thrombotic microangiopathy
  • Oxaliplatin (Eloxatin, Oxaliplatin Medac) (see Oxaliplatin, [[Oxaliplatin]])
    • Epidemiology: case reports defining an association with thrombotic microangiopathy
  • Penicillin (see Penicillin, [[Penicillin]])
    • Epidemiology: case reports defining an association with thrombotic microangiopathy
  • Quetiapine (Seroquel) (see Quetiapine, [[Quetiapine]])
    • Epidemiology: case reports defining an association with thrombotic microangiopathy
      • May recur with repeated exposures
  • Quinine (see Quinine, [[Quinine]])
    • Epidemiology: strong evidence for association with thrombotic microangiopathy
  • Sulfamethoxazole-Trimethoprim (Bactrim, Septra) (see Sulfamethoxazole-Trimethoprim, [[Sulfamethoxazole-Trimethoprim]])
    • Epidemiology: strong evidence for association with thrombotic microangiopathy

Toxin-Mediated

  • Bone Marrow Transplant (BMT)/Stem Cell Transplant (SCT) (see Hematopoietic Stem Cell Transplant, [[Hematopoietic Stem Cell Transplant]])
    • Epidemiology: occurs in 1-20% of cases
      • Occurs with either autologous or allogenenic transplant
    • Physiology: patients typically have received multiple therapies which may be contributory (radiation therapy, cytotoxic chemotherapy, and/or immunosuppressive agents)
  • Calcineurin Inhibitors (see Calcineurin Inhibitors, [[Calcineurin Inhibitors]])
    • Agents
      • Cyclosporine A (CSA) (see Cyclosporine A, [[Cyclosporine A]])
      • Tacrolimus (FK-506, Fujimycin, Prograf, Advagraf, Protopic, Hecoria, Astagraf XL) (see Tacrolimus, [[Tacrolimus]])
    • Physiology: dose-dependent endothelial dysfunction and platelet aggregation (possibly mediated by inhibition of prostacyclins)
    • Clinical: organ involvement is usually restricted to the kidneys with acute kidney injury (AKI) (see Acute Kidney Injury, [[Acute Kidney Injury]])
  • Cocaine (see Cocaine, [[Cocaine]])
    • Epidemiology: case reports defining an association with thrombotic microangiopathy
  • Ecstasy (see Ecstasy, [[Ecstasy]])
    • Epidemiology: case reports defining an association with thrombotic microangiopathy
  • Gemcitabine (Gemzar) (see Gemcitabine, [[Gemcitabine]])
    • Epidemiology: strong evidence for association with thrombotic microangiopathy
    • Physiology: dose-dependent toxicity
  • Mitomycin (Mitomycin-C) (see Mitomycin, [[Mitomycin]])
    • Epidemiology: strong evidence for association with thrombotic microangiopathy
    • Physiology: dose-dependent toxicity
  • Oxymorphone (see Oxymorphone, [[Oxymorphone]]): when long-acting Opana ER is used intravenously as a recreational drug
  • Pentostatin (Nipent, Deoxycoformycin) (see Pentostatin, [[Pentostatin]])
    • Epidemiology: case reports defining an association with thrombotic microangiopathy
  • Vascular Endothelial Growth Factor (VEGF) Inhibitors
    • Agents
      • Bevacizumab (Avastin) (see Bevacizumab, [[Bevacizumab]]): anti-VEGF monoclonal antibody
      • Sunitinib (Sutent) (see Sunitinib, [[Sunitinib]]): small molecule tyrosine kinase inhibitor, targeting multiple receptors (c-kit, VEGFR1-3, PDGFR-alpha, PDGFR-beta, FLT3, CSF-1R, and REarranged during Transfection; RET)
  • Vincristine (see Vincristine, [[Vincristine]])
    • Epidemiology: case reports defining an association with thrombotic microangiopathy

Physiology

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Diagnosis

ADAMTS 13 Activity (see ADAMTS 13 Activity, [[ADAMTS 13 Activity]])

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Clinical Manifestations

Other Manifestations

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Treatment

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References

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