Differential diagnosis of microangiopathic anemia

What are the differential diagnosis of microangiopathic anemia: 

a. Sepsis 
b. Hemolytic uremic syndrome 
c. MI 
d. Eclampsia 
e. Scleroderma

Ans. is a, b and d i.e. Sepsis; Hemolytic uremic syndrome; and Eclampsia

• Microangiopathic hemolytic anemia is characterized by mechanical damage and fragmentation of RBC as they traverse through abnormal circulation which is most commonly caused by widespread fibrin deposition in small vessels.
• Causes of microangiopathic hemolytic anemia:

— Disseminated intravascular coagulation (DIC) — Thrombotic thrombocytopenic purpura (HP)

— Hemolytic—uremic syndrome (HUS) — Eclampsia (HELLP syndrome)

— Disseminated cancer — Malignant hypertension

— Renal allograft rejection — Vasculitis of all types

• Note that trauma and hemolysis of RBC by prosthetic valves comes under “microvascular traumatic hemolysis” not microangiopathic hemolysis, although the consequences (i.e., fragmented RBC) are the same.