Results
Total 73 transplants (51 allogeneic, 22 autologous) had been performed in 63 patients during the study period. Six patients (4 males and 2 females) developed TA-TMA at a median duration of 2.5 months post-HSCT. Incidence rate was 9.52%. For the six TA-TMA patients, five underwent allogenic HSCT while one underwent autologous HSCT. Three out of six cases of TA-TMA were histologically proven. Demographics and transplant details are described in Table 1a . All five patients who underwent allogeneic HSCT developed various degrees of acute graft-versus-host disease (GVHD) and viral infections. Four used calcineurin inhibitor (CNI) cyclosporine (CSA) as GVHD prophylaxis which was stopped once TA-TMA was suspected. Three out of six patients developed hepatic sinusoidal obstruction syndrome with defibrotide given. Genetic predisposition had not been identified in local cohort except identification of a variant of unknown significance in THBD gene for Case 6 (Table 1b) . All six patients developed hypertension, proteinuria, schistocytosis with elevated LDH. Five out of six had anemia, thrombocytopenia, elevated creatinine, elevated d-dimer and low haptoglobin level (Table 1b) . Median six doses (range 4 to 12 doses) of eculizumab were administered to four out of six patients. Serum eculizumab level was not performed due to unavailability of the test. Three patients died (2 due to fungal infection and one due to acute-on-chronic renal failure) (Cases 1 to 3) and all within 3 months upon diagnosis of TA-TMA. Mortality rate was 50%. All three survivors (Cases 4 to 6) suffered from chronic kidney disease (CKD) and one (Case 5) required lifelong dialysis(Table 1c) .