Objective To explore clinical characteristics and treatment of the thrombotic microangiopathy(TMA), to improve the recognition of TMA. Methods The clinical manifestations, laboratory examinations, therapeutic methods and prognosis of 12 TMA patients were analyzed retrospectively. Results The clinical manifestations were characterized by microangiopathic hemolytic anemia(12/12), thrombocytopenia(12/12), renal lesion(12/12), fever(7/12), and neurological abnormalities or mental disorders(6/12). Eight patients were treated by plasma exchange therapy, 1 patient died from a complication(1/8); 7 patients were discharged with improved condition(7/8). Four of the other patients were treated by plasma transfusion(4/12), 1 patient died from TMA(1/4); 3 patients were discharged with improved condition(3/4). Conclusion TMA is a severe acute syndrome with various clinical manifestations, complicated pathogenesis and high mortality. It is important to increase the awareness and provide early diagnosis of TMA in order to improve prognosis and reduce mortality.