A modified TA-TMA management algorithm that incorporates CNS manifestations of TA-TMA in treatment decisions. As previously published, low risk TA-TMA is limited to laboratory evidence of intravascular hemolysis without end organ injury or increased terminal complement activation.^1,11,15,20  Moderate risk TA-TMA is defined as the presence of either a random urine protein creatinine ratio >2 mg/mg or an elevated plasma sC5b-9 level (terminal complement, normal range <244 ng/mL).^{1,11,15,20,53}  High-risk TA-TMA includes patients with both of these laboratory abnormalities as well as patients with TA-TMA diagnosed on tissue biopsy.^1,11,15,20  We propose the inclusion of neurologic symptoms or brain imaging findings potentially attributable to TA-TMA into the treatment decision process, as these patients may have CNS TA-TMA and early initiation of complement inhibitors may limit morbidity from TA-TMA–mediated brain injury.