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Correspondence
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Volume 346:1332-1334 April 25, 2002 Number 17
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The Hemolytic–Uremic Syndrome

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To the Editor: The data reported by Chandler et al. (Jan. 3 issue)1 support the possibility of a severe prothrombotic disturbance in the hemolytic–uremic syndrome, suggesting that the generation of thrombin and inhibition of fibrinolysis precede renal injury and may be the cause of such injury. These data could help to distinguish diarrhea-associated hemolytic–uremic syndrome from thrombotic thrombocytopenic purpura and to identify relapsing hemolytic–uremic syndrome in which there is a deficiency of a specific von Willebrand factor–cleaving protease, resulting in large multimers that promote platelet aggregation.2 These coagulation abnormalities may also help to explain why plasma exchange, which is an . . . [Full Text of this Article]

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