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Dear Editor, Thrombotic microangiopathies (TMAs) are a rare group of disorders having similar presenting and laboratory features, ie, microangiopathic hemolytic anemia (MAHA), thrombocytopenia, and end-organ capillary thrombosis.[1] The wide array of differences in the etiology of TMAs and the availability of specific, effective treatment options make their accurate diagnosis a necessity. Various scoring systems like the “PLASMIC” score,“French” score, and “Bently” score help make a tentative diagnosis for the cause of TMA and initiate life-saving treatments.[2] While the above scoring systems are helpful in most cases, diagnosis and management can become challenging in the occasional scenario where these labs show conflicting results. In such situations, clinical judgment must salvage patients in the acute setting, but genetic testing may help provide a definitive diagnosis for long-term management …