Phase 1 · Understand the Body — Why the disease behaves the way it does.
The One-Line Truth
The whole disease in one chain
Everything on this page exists to explain this line.
MAHA is red blood cell destruction (hemolysis) caused by red blood cells being physically sheared apart as they squeeze through abnormal clots or damaged tiny blood vessels.
Highway pileup with shattered windshields
Imagine a multi-lane highway where the road surface suddenly cracks and buckles (endothelial injury), forcing cars to swerve into narrow, debris-filled lanes. Some lanes fill with tangled wire mesh (fibrin strands and microthrombi) that blocks traffic. Cars trying to squeeze through get their windshields shattered by the sharp edges (red cells fragmented into schistocytes). The shattered glass piles up faster than the highway department can sweep it away (hemolysis exceeds marrow production), and the wreckage clogs traffic downstream, cutting off oxygen delivery to hospitals and homes (organ starved blood flow (ischemia)). Meanwhile, the cleanup crew (the spleen) works overtime trying to remove glass shards, but eventually gets overwhelmed.
American Society of Hematology (ASH) 2020 Guidelines for Management of Thrombotic Thrombocytopenic Purpura · American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin No. 222: Gestational Hypertension and Preeclampsia (2020) · Scully M et al. A phase 2 study of the safety and efficacy of rituximab with plasma exchange in acute acquired thrombotic thrombocytopenic purpura. Blood. 2011;118(7):1746-1753 · George JN, Nester CM. Syndromes of thrombotic microangiopathy. New England Journal of Medicine. 2014;371(7):654-666 · reviewed 2026-08-29