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Whilst the pathophysiology underlying the diverse thrombotic microangiopathy syndromes is better understood, management of these entities and of the various therapeutic options currently available remains challenging. Early identification of these syndromes is essential to improving prognosis. In the absence of treatment, mortality is high, including in the first days following diagnosis. We present a summary of the diagnostic strategy and therapeutic management of thrombotic microangiopathy in adults.Acute mesenteric ischemia is a rare diagno