Hence, even though typical features of thrombotic microangiopathy (e.g. schizocytes) are usually not found in dengue and the etiology of dengue-associated thrombocytopenia is multifactorial, we suggest that the observed changes in VWF-ADAMTS-13 play a role in the pathogenesis of DHF/DSS and in the etiology of thrombocytopenia in special. Here, ADAMTS13 is linked to thrombotic microangiopathy.