To Determine Diagnosis
To establish MAHA diagnosis - based upon history, examination and laboratory picture:
  • FBC
  • Blood film
  • Reticulocyte count
  • LDH and bilirubin
  • Coagulation including fibrinogen
  • Coombs test (Direct Antiglobulin Test)
  • Urinalysis
Definitive testing:
If suspected, do not wait to treat!
  • ADAMTS13 activity
  • Anti-ADAMTS13 Ab
  • Sequencing of ADAMTS13 gene
To Determine Aetiology
  • Pregnancy test
  • Virology screen - before PLEX:
    • HIV
    • HBV / HCV
    • CMV
  • Autoimmune screen (assess for SLE / APL):
    • ANA / ACA / RF
    • Lupus anticoagulant
  • Thyroid Function Tests (for Graves)
  • If diarrhoea: stool culture for e.coli
To Assess for Complications
Determine organ involvement:
  • Renal function tests and urinalysis
  • ECG and troponin
  • CT / MRI Brain
  • Amylase
To Exclude Differentials
  • Shiga toxin
  • Echo suspicion of endocarditis / valve dysfunction