Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA.
Hematology-Oncology Section, Department of Medicine, Boston University School of Medicine, Boston, MA.
Am J Kidney Dis. 2017 Nov;70(5):715-721. doi: 10.1053/j.ajkd.2017.05.017. Epub 2017 Jul 15.
Thrombotic microangiopathy (TMA) is characterized by the presence of microangiopathic hemolytic anemia and thrombocytopenia along with organ dysfunction, and pathologically, by the presence of microthrombi in multiple microvascular beds. Delays in diagnosis and initiation of therapy are common due to the low incidence, variable presentation, and poor awareness of these diseases, underscoring the need for interdisciplinary approaches to clinical care for TMA. We describe a new approach to improve clinical management via a TMA team that originally stemmed from an Affinity Research Collaborative team focused on thrombosis and hemostasis. The TMA team consists of clinical faculty from different disciplines who together are charged with the responsibility to quickly analyze clinical presentations, guide laboratory testing, and streamline prompt institution of treatment. The TMA team also includes faculty members from a broad range of disciplines collaborating to elucidate the pathogenesis of TMA. To this end, a clinical database and biorepository have been constructed. TMA leaders educate front-line providers from other departments through presentations in various forums across multiple specialties. Facilitated by an Affinity Research Collaborative mechanism, we describe an interdisciplinary team dedicated to improving both clinical care and translational research in TMA.
血栓性微血管病(TMA)的特征是存在微血管病性溶血性贫血和血小板减少症以及器官功能障碍,病理上存在多个微脉管中的微血栓。由于这些疾病的发病率低、表现多样且认知度低,导致诊断和治疗的延误很常见,这突显了需要采用跨学科方法来进行 TMA 的临床护理。我们描述了一种通过 TMA 团队改善临床管理的新方法,该团队最初源自一个专注于血栓形成和止血的亲和力研究协作团队。TMA 团队由来自不同学科的临床教师组成,共同负责快速分析临床表现、指导实验室检测,并简化及时开始治疗的流程。TMA 团队还包括来自广泛学科的教师成员,共同阐明 TMA 的发病机制。为此,已经构建了一个临床数据库和生物库。TMA 负责人通过在多个专业的各种论坛上进行演讲,向其他部门的一线医护人员进行教育。在亲和力研究协作机制的推动下,我们描述了一个致力于改善 TMA 的临床护理和转化研究的跨学科团队。