{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T14:24:55Z","timestamp":1792592695808,"version":"4.5.0"},"reference-count":45,"publisher":"American Society of Hematology","issue":"23","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,12,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Most children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have mild or minimal disease, with a small proportion developing severe disease or multisystem inflammatory syndrome in children (MIS-C). Complement-mediated thrombotic microangiopathy (TMA) has been associated with SARS-CoV-2 infection in adults but has not been studied in the pediatric population. We hypothesized that complement activation plays an important role in SARS-CoV-2 infection in children and sought to understand if TMA was present in these patients. We enrolled 50 hospitalized pediatric patients with acute SARS-CoV-2 infection (n = 21, minimal coronavirus disease 2019 [COVID-19]; n = 11, severe COVID-19) or MIS-C (n = 18). As a biomarker of complement activation and TMA, soluble C5b9 (sC5b9, normal 247 ng\/mL) was measured in plasma, and elevations were found in patients with minimal disease (median, 392 ng\/mL; interquartile range [IQR], 244-622 ng\/mL), severe disease (median, 646 ng\/mL; IQR, 203-728 ng\/mL), and MIS-C (median, 630 ng\/mL; IQR, 359-932 ng\/mL) compared with 26 healthy control subjects (median, 57 ng\/mL; IQR, 9-163 ng\/mL; P &amp;lt; .001). Higher sC5b9 levels were associated with higher serum creatinine (P = .01) but not age. Of the 19 patients for whom complete clinical criteria were available, 17 (89%) met criteria for TMA. A high proportion of tested children with SARS-CoV-2 infection had evidence of complement activation and met clinical and diagnostic criteria for TMA. Future studies are needed to determine if hospitalized children with SARS-CoV-2 should be screened for TMA, if TMA-directed management is helpful, and if there are any short- or long-term clinical consequences of complement activation and endothelial damage in children with COVID-19 or MIS-C.<\/jats:p>","DOI":"10.1182\/bloodadvances.2020003471","type":"journal-article","created":{"date-parts":[[2020,12,9]],"date-time":"2020-12-09T22:57:43Z","timestamp":1607554663000},"page":"6051-6063","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":128,"title":["Evidence of thrombotic microangiopathy in children with SARS-CoV-2 across the spectrum of clinical presentations"],"prefix":"10.1182","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8005-3836","authenticated-orcid":false,"given":"Caroline","family":"Diorio","sequence":"first","affiliation":[{"name":"Immune Dysregulation Frontier Program, Department of 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