SHM Converge Scientific Abstract ePoster Gallery-Microangiopathic Hemolytic Anemia Associated With Malignant Hypertension

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This case describes a 39-year-old African American man with stage III chronic kidney disease, hypertension, and polysubstance use who presented with one week of dyspnea and hematuria. On arrival, he had severe hypertension (203/143), acute kidney injury with creatinine rising to 9.34 from a baseline of 1.3–1.7, anemia, thrombocytopenia, elevated LDH, low haptoglobin, and schistocytes on peripheral smear, consistent with microangiopathic hemolytic anemia (MAHA).<br /><br />Because MAHA can be caused by malignant hypertension, TTP, HUS, DIC, or other thrombotic microangiopathies, the team initially considered urgent plasma exchange. However, the clinical picture favored hypertensive crisis: marked blood pressure elevation, severe renal failure, minimal schistocytes, and no neurologic findings or other classic TTP features. Blood pressure was treated with IV labetalol and hydralazine, along with IV Lasix for volume overload, and plasmapheresis was not started.<br /><br />The patient’s anemia and thrombocytopenia improved with blood pressure control alone, supporting malignant hypertension-induced MAHA. Later testing showed normal ADAMTS13 and complement levels, helping rule out TTP and atypical HUS. DAT and multiple myeloma workup were negative. Renal biopsy revealed moderate-to-severe arterionephrosclerosis consistent with acute hypertensive injury. Although the hematologic abnormalities resolved, the patient still required hemodialysis for acute renal failure.<br /><br />Overall, the case highlights that severe hypertension can cause MAHA and mimic TTP. Careful attention to the temporal relationship between hypertension and hemolysis, along with laboratory evaluation, can help avoid unnecessary plasmapheresis. Blood pressure control is the key initial treatment.

Asset Subtitle

Jason Y. Chang

Meta Tag

Author List Guangchen Zou, Jason Y. Chang, Matthew T. Barbery, Mingwei Yu, Minje Ha

Category Clinical Vignettes

Concept Microangiopathic Hemolytic Anemia

Concept Malignant Hypertension

Concept Thrombotic Microangiopathy

Concept Blood Pressure Control

Concept Thrombotic Thrombocytopenic Purpura

Distinguished Non-Finalist

Presenter Organization Danbury Hospital

Presenting Author Jason Y. Chang

Track Adult

Keywords

malignant hypertension

microangiopathic hemolytic anemia

acute kidney injury

thrombotic thrombocytopenic purpura

hypertensive crisis

schistocytes

ADAMTS13

hemodialysis

arterionephrosclerosis

plasma exchange

Microangiopathic Hemolytic Anemia

Malignant Hypertension

Thrombotic Microangiopathy

Blood Pressure Control

Thrombotic Thrombocytopenic Purpura