Document Type
Article
Publication Title
Hematology, Transfusion and Cell Therapy
Abstract
COVID-19-associated thrombotic microangiopathy has emerged as a severe complication that exacerbates morbidity and mortality in critical cases. Thrombotic microangiopathy, characterized by microvascular thrombosis and endothelial injury, includes conditions like thrombotic thrombocytopenic purpura and atypical hemolytic uremic syndrome. This review investigates therapeutic plasma exchange as a potential strategy to mitigate COVID-19-induced thrombotic microangiopathy, examining its role in removing pro-inflammatory cytokines, immune complexes, and pro-thrombotic factors. Additionally, it highlights the synergistic effects when therapeutic plasma exchange is combined with treatments such as complement inhibitors and immunosuppressants. Preliminary evidence, drawn from case reports and early trials, supports the efficacy of therapeutic plasma exchange in improving outcomes for COVID-19-associated thrombotic microangiopathy. However, larger randomized controlled trials are necessary to definitively establish its place in COVID-19 management, particularly for high-risk and transplant patients with underlying immunological vulnerabilities.
DOI
10.1016/j.htct.2025.103963
Publication Date
8-23-2025
Keywords
COVID-19, Coagulopathy, Plasma exchange, Thrombotic microangiopathy
ISSN
2531-1387
Recommended Citation
Baykara Y, Sevgi K, Akgun Y. COVID-19 Microangiopathy: Insights into Plasma Exchange as a Therapeutic Strategy. Hematology, Transfusion and Cell Therapy. 2025; 47(4). doi: 10.1016/j.htct.2025.103963.
