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Introducción: Las microangiopatías trombóticas (MAT) comprenden un espectro heterogéneo caracterizado por daño endotelial, anemia hemolítica microangiopática y trombocitopenia. El principal desafío es establecer un diagnóstico diferencial sólido y certero ante la demora en exámenes confirmatorios que permitan discriminar entre simuladores de una etiología primaria o secundaria para definir una conducta clínica.
Materiales y métodos: Se realizó una revisión en la literatura en bases de datos indexadas restringida a metaanálisis, ensayos clínicos y revisiones publicados entre el 1 de enero de 2021 y el 1 de junio de 2026. Se seleccionaron estudios sobre mecanismos fisiopatológicos moleculares, escalas de predicción clínica y hallazgos en biopsia renal.
Resultados: El diagnóstico y tratamiento oportuno de las MAT dependen de la sospecha precoz asociada a la integración clínica de escalas pronósticas, como PLASMIC score, para descartar Púrpura trombocitopénica trombótica (PTT) mientras se procesan los laboratorios específicos. Por otro lado, es importante diferenciar causas simuladoras de MAT donde el laboratorio resulta decisivo. Como parte del estudio diagnóstico y pronóstico, se encuentra la biopsia renal, la cual presenta hallazgos histológicos que también exigen una revisión y correlación clínica acuciosa al ser interpretados.
Discusión: El diferencial oportuno de las MAT requiere la integración tanto del juicio clínico como de exámenes complementarios. El uso razonado de escalas predictivas, en conjunto con exámenes de laboratorio permiten discriminar entre las MAT verdaderas y sus simuladores, identificando de forma precoz la PTT para orientar asertivamente la toma de decisiones terapéuticas críticas.
Abstract
Introduction: Thrombotic microangiopathies comprise a heterogeneous spectrum characterized by endothelial damage, microangiopathic hemolytic anemia, and thrombocytopenia. The primary challenge lies in establishing a robust and accurate differential diagnosis in the face of delayed confirmatory testing, which is essential to discriminate between primary and secondary etiologies and to guide clinical management.
Materials and Methods: A literature review was conducted across indexed databases, restricted to meta-analyses, clinical trials and reviews published between January 1, 2021, and June 1, 2026. Studies focused on molecular pathophysiological mechanisms, clinical prediction scores and renal biopsy findings were selected.
Results: The timely diagnosis and management of TMA depend on early clinical suspicion combined with the integration of prognostic scoring systems, such as the PLASMIC score, to rule out thrombotic thrombocytopenic purpura while specific laboratory samples are being processed. Concurrently, differentiating thrombotic microangiopathies mimics is crucial, in which laboratory results remain decisive. As part of the diagnostic and prognostic evaluation, renal biopsy reveals histological findings that also demand thorough review and rigorous clinical correlation during interpretation.
Discussion: The timely differential diagnosis of thrombotic microangiopathies requires the integration of both clinical judgment and complementary investigations. The rational use of predictive scores, in conjunction with laboratory testing, enables the discrimination between true thrombotic microangiopathies and their mimics, allowing for the early identification of thrombotic thrombocytopenic purpura to assertively guide critical therapeutic decision-making.
Key words: Thrombotic Microangiopathies; Purpura, Thrombotic Thrombocytopenic; Plasma exchange; Biopsy.
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Derechos de autor 2026 Melania Zepeda G. , Anghelo Zurita D., Yasna Rojel G., Ignacio Hernández A., Alejandro Solari L., Vicente Abarza D., María Gothe G. (Autor/a)