Two Unusual Cases of Thrombotic Microangiopathies

Thrombotic microangiopathies (TMA) can be attributed to a wide variety of causes and the diagnostic process is often challenging, especially when the clinical scenario is full of other confounding factors. Hemolysis can be due to complement-mediated thrombotic microangiopathies and drug-induced hemolytic anemia in the appropriate clinical context. In this case presentation, two patients with TMA including a patient diagnosed with complement-mediated TMA after a through screen of other differential diagnoses, and a multiple myeloma patient on chemotherapy with primaquine-induced hemolytic anemia in the background of treatment for possible pneumocystis jirovecii pneumonia. A thorough review of the drug history of patients presenting with TMA should be conducted, along with a heightened index of suspicion for complement-mediated disorders such as complement-mediated TMA, which should be entertained after ruling out a wide variety of differential diagnoses.