Abstract:

Objective To analyze the clinical characteristics of transplantation-associated thrombotic microangiopathy （TA-TMA） after hematopoietic stem cell transplantation （HSCT）. Methods A total of 185 patients undergoing HSCT were enrolled. Totally,11 cases were confirmed as TA-TMA （case group）,and 30 non-TA-TMA cases with similar age,transplantation ways and human leukocyte antigen matching donor were enrolled as control group. The ratios of broken red blood cells in peripheral blood between the 2 groups were compared,and the laboratory indicators and clinical characteristics of 11 cases of TA-TMA were analyzed. Results Of the 185 patients undergoing HSCT,11 cases （5.9%,11/185） were TA-TMA. The age was 33（7-45） years old,and the onset time after transplantation was 76（22-152） d. The ratio of broken red blood cells in case group was 3.3%,which was higher than that in control group （0.4%）（P<0.05）. In the 11 cases of TA-TMA,hemoglobin （Hb） level and platelet （PLT）count decreased progressively,and lactate dehydrogenase （LDH）,serum creatinine（Cr）,serum total bilirubin（TB）,C-reactive protein（CRP）,procalcitonin （PCT） and cyclosporin A （CsA） were at high levels. There were 8 cases with acute and chronic graft-versus-host diseases（GVHD） and 6 cases with positive 24 h urinary protein. Except 1 case was not detected for virus DNA,and the other cases were associated with more than 1 type of virus disease. Only 4 cases were alive until the end of follow-up period. Conclusions TA-TMA is an extremely serious complication after bone marrow transplantation. The prognosis is poor,when GVHD is combined. The determinations of a number of early laboratory indicators are necessary for the early diagnosis and treatment of TA-TMA to decrease mortality.

Key words: Transplantation-associated thrombotic microangiopathy, Hematopoietic stem cell transplantation, Clinical characteristic