COVID-19 Microangiopathy: Insights into plasma exchange as a therapeutic strategy

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 a...

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Main Authors: Yigit Baykara, Kaan Sevgi, Yamac Akgun
Format: Article
Language:English
Published: Elsevier 2025-10-01
Series:Hematology, Transfusion and Cell Therapy
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Online Access:http://www.sciencedirect.com/science/article/pii/S2531137925002317
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author Yigit Baykara
Kaan Sevgi
Yamac Akgun
author_facet Yigit Baykara
Kaan Sevgi
Yamac Akgun
author_sort Yigit Baykara
collection DOAJ
description 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.
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spelling doaj-art-7041c07ac2ea43988d416260993035492025-08-24T05:13:59ZengElsevierHematology, Transfusion and Cell Therapy2531-13792025-10-0147410396310.1016/j.htct.2025.103963COVID-19 Microangiopathy: Insights into plasma exchange as a therapeutic strategyYigit Baykara0Kaan Sevgi1Yamac Akgun2Stanford University Department of Pathology, Stanford, USAKansas City University of Medicine and Biosciences, Kansas City, MO, USAUniversity of Miami Miller School of Medicine, Miami, FL, USA; Corresponding author at: Children's Hospital Los Angeles, USA.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.http://www.sciencedirect.com/science/article/pii/S2531137925002317COVID-19Plasma exchangeThrombotic microangiopathyCoagulopathy
spellingShingle Yigit Baykara
Kaan Sevgi
Yamac Akgun
COVID-19 Microangiopathy: Insights into plasma exchange as a therapeutic strategy
Hematology, Transfusion and Cell Therapy
COVID-19
Plasma exchange
Thrombotic microangiopathy
Coagulopathy
title COVID-19 Microangiopathy: Insights into plasma exchange as a therapeutic strategy
title_full COVID-19 Microangiopathy: Insights into plasma exchange as a therapeutic strategy
title_fullStr COVID-19 Microangiopathy: Insights into plasma exchange as a therapeutic strategy
title_full_unstemmed COVID-19 Microangiopathy: Insights into plasma exchange as a therapeutic strategy
title_short COVID-19 Microangiopathy: Insights into plasma exchange as a therapeutic strategy
title_sort covid 19 microangiopathy insights into plasma exchange as a therapeutic strategy
topic COVID-19
Plasma exchange
Thrombotic microangiopathy
Coagulopathy
url http://www.sciencedirect.com/science/article/pii/S2531137925002317
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AT kaansevgi covid19microangiopathyinsightsintoplasmaexchangeasatherapeuticstrategy
AT yamacakgun covid19microangiopathyinsightsintoplasmaexchangeasatherapeuticstrategy