Three complementary assays were used to determine ADAMTS13 levels, all obtained from Technoclone (Vienna, Austria). TECHNOZYM ADAMTS13 Activity ELISA is a chromogenic assay in which the endpoint is proteolysis of the substrate GST-VWF73 [21,22]. TECHNOFLUOR ADAMTS13 Activity is an automated assay for the Ceveron s100 instrument which uses a FRET substrate based on the VWF73 peptide [23]. TECHNOZYM ADAMTS13 Antigen ELISA is a sandwich ELISA employing anti-ADAMTS 13 antigen directed to the CUB domain and secondary HRP labelled anti-ADAMTS13 polyclonal antibodies [24]. All ADAMTS13 parameters were calculated using assay specific reference plasma calibrated against the WHO standard. The COVID-19 patient samples were analysed alongside a control plasma sample from a 48 year old male with autoimmune TTP (known ADAMTS13 activity <0.01 IU/mL) and a normal pooled plasma sample (ADAMTS13 activity 0.9–1.0 IU/mL; Precision BioLogic, Dartmouth, NS, Canada).

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