Which finding is characteristic of thrombotic microangiopathy such as TTP?

• A. Microangiopathic hemolytic anemia with schistocytes on smear
• B. Peripheral neuropathy without anemia
• C. Hypercoagulability with D-dimer
• D. Elevated platelets

Answer: (A)

Thrombotic microangiopathy causes tiny blood vessel thrombi that shear passing red blood cells, leading to microangiopathic hemolytic anemia. The hallmark is schistocytes on the peripheral smear, reflecting fragmented RBCs from this intravascular destruction. This MAHA goes hand in hand with consumption of platelets, so you’d expect low platelets rather than elevated ones. Lab clues include elevated LDH and low haptoglobin from hemolysis. While neurologic symptoms can occur in TTP, the defining finding here is the presence of schistocytes indicating MAHA. Options suggesting peripheral neuropathy without anemia, a hypercoagulable state with D-dimer, or elevated platelets do not capture this intravascular hemolysis and platelet consumption pattern.