A Case of Thrombotic Microangiopathy Secondary to Hypertensive Emergency: Presentation, Management, and Distinguishing Features

Thrombotic microangiopathies (TMA) are a group of conditions that present with varying degrees of microthrombi, thrombocytopenia, microangiopathic hemolytic anemia, renal dysfunction, and neurological impairment. Etiologies can be primary, such as thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), and atypical hemolytic uremic syndrome (aHUS), or secondary, such as due to systemic infections, malignancies, immune-mediated conditions, and hypertensive emergencies. In hypertensive emergencies, this presentation can occur from mechanical stress placed on red blood cells as they pass through narrowed arteries due to edema and microangiopathic changes within the vessels themselves. In TMA secondary to hypertensive emergencies (HTN-TMA), blood pressure control alone can lead to improvement in cytopenias. We present a case of a 48-year-old male with HTN-TMA. The patient had normalization of thrombocytopenia and improvement in anemia with adequate blood pressure control. This case highlights the difficulty in making this diagnosis due to overlapping presentations with primary thrombotic microangiopathies and the extensive etiologies that should be considered as part of a differential diagnosis.