This session will review the diseases that are characterized by microvascular thrombosis with consequent thrombocytopenia and hemolytic anemia. Recent advances in our understanding of these diseases suggest that they may be driven by diverse and sometimes overlapping pathophysiology, including toxin-mediated endothelial injury, disorders of complement, and/or deficiency of ADAMTS13. We will introduce emerging therapeutic approaches that target vWF, including gene therapy. We will also discuss the emerging evidence of the use of novel pharmacologic targeting of complement or proteasome complex in specific circumstances.