Acquired von Willebrand syndrome caused by the loss of high-molecular-weight multimers of von Willebrand factor due to high shear stress under ECMO, complications associated with heparin-induced thrombocytopenia and thrombotic microangiopathy, and many other factors can be potential mechanisms of thrombotic and bleeding events during ECMO management.[9,10] In the current case, COVID-19-associated coagulopathy, inflammation, and endothelial cell dysfunction may have affected the EIC. The gene discussed is VWF; the disease is Genetic thrombotic microangiopathy.