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TMA should be considered in all patients with thrombocytopenia and anaemia, with an immediate request to the haematology laboratory to look for red cell fragments on a blood film. While TMA of any aetiology generally demands prompt treatment, this is especially so in thrombotic thrombocytopenic purpura (TTP) and atypical haemolytic uraemic syndrome (aHUS), where organ failure may be precipitous, irreversible and fatal. In all adults, urgent, empirical plasma exchange (PE) should be started within 4\u20138\u2009h of presentation for a possible diagnosis of TTP, pending a result for ADAMTS13 activity (a disintegrin and metalloprotease thrombospondin, number 13). A sodium citrate plasma sample should be collected for ADAMTS13 testing prior to any plasma therapy. In children, Shiga toxin\u2010associated haemolytic uraemic syndrome due to infection with <jats:styled-content style=\"fixed-case\"><jats:italic>Escherichia coli<\/jats:italic><\/jats:styled-content> (STEC\u2010HUS) is the commonest cause of TMA, and is managed supportively. If TTP and STEC\u2010HUS have been excluded, a diagnosis of aHUS should be considered, for which treatment is with the monoclonal complement C5 inhibitor, eculizumab. While early confirmation of aHUS is often not possible, except in the minority of patients in whom autoantibodies against factor H are identified, genetic testing ultimately reveals a complement\u2010related mutation in a significant proportion of aHUS cases. The presence of other TMA\u2010associated conditions (e.g. infection, pregnancy\/postpartum and malignant hypertension) does not exclude TTP or aHUS as the underlying cause of TMA.<\/jats:p>","DOI":"10.1111\/nep.13234","type":"journal-article","created":{"date-parts":[[2018,2,8]],"date-time":"2018-02-08T14:42:41Z","timestamp":1518100961000},"page":"507-517","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Consensus opinion on diagnosis and management of thrombotic microangiopathy in Australia and New Zealand"],"prefix":"10.1111","volume":"23","author":[{"given":"Lucy C","family":"Fox","sequence":"first","affiliation":[{"name":"Transfusion Research Unit, Department of Epidemiology and Preventive Medicine Monash University  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Solomon J","family":"Cohney","sequence":"additional","affiliation":[{"name":"Transfusion Research Unit, Department of Epidemiology and Preventive Medicine Monash University  Melbourne Victoria Australia"},{"name":"Department of Medicine University of Melbourne  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua Y","family":"Kausman","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Murdoch Children's Research Institute Royal Children's Hospital  Melbourne Victoria Australia"},{"name":"Department of Paediatrics University of Melbourne  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jake","family":"Shortt","sequence":"additional","affiliation":[{"name":"Monash Haematology, Monash Health, Monash University  Melbourne Victoria Australia"},{"name":"School of Clinical Sciences Monash Health, Monash University  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter D","family":"Hughes","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Melbourne  Melbourne Victoria Australia"},{"name":"Department of Nephrology Royal Melbourne Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica M","family":"Wood","sequence":"additional","affiliation":[{"name":"Transfusion Research Unit, Department of Epidemiology and Preventive Medicine Monash University  Melbourne Victoria Australia"},{"name":"Monash Haematology, Monash Health, Monash University  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole M","family":"Isbel","sequence":"additional","affiliation":[{"name":"Department of Nephrology Princess Alexandra Hospital  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3804-0641","authenticated-orcid":false,"given":"Theo","family":"de Malmanche","sequence":"additional","affiliation":[{"name":"New South Wales Health Pathology, Immunology  Newcastle New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Durkan","sequence":"additional","affiliation":[{"name":"Department of Nephrology The Children's Hospital at Westmead  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pravin","family":"Hissaria","sequence":"additional","affiliation":[{"name":"Department of Immunology Royal Adelaide Hospital  Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piers","family":"Blombery","sequence":"additional","affiliation":[{"name":"Transfusion Research Unit, Department of Epidemiology and Preventive Medicine Monash University  Melbourne Victoria Australia"},{"name":"Department of Pathology Peter MacCallum Cancer Centre  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3610-5053","authenticated-orcid":false,"given":"Thomas D","family":"Barbour","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Melbourne  Melbourne Victoria Australia"},{"name":"Department of Nephrology Royal Melbourne Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,6,10]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(52)90022-3"},{"key":"e_1_2_14_3_1","first-page":"905","article-title":"H\u00e4molytisch\u2010ur\u00e4mische Syndrome: Bilaterale Nierenrindennekrosen bei akuten erworbenen h\u00e4molytischen An\u00e4mien [Hemolytic\u2010uremic syndrome: Bilateral necrosis of the renal cortex in acute acquired hemolytic anemia]","volume":"85","author":"Gasser C","year":"1955","journal-title":"Schweiz. 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