Thrombotic thrombocytopenic purpura (TTP) is an acute syndrome with abnormalities in multiple organ systems, characterised by fever, thrombocytopenia, microangiopathic hemolytic anemia (MAHA) and often with neurologic and renal dysfunction. However, this classical pentad is only rarely seen, and management requires early identification and initiation of plasma exchange. Currently only the dyad of unexplained thrombocytopenia and microangiopathic haemolytic anaemia is required to diagnose thrombotic microangiopathy. With increasing use of therapeutic plasma exchange, TTP is now a potentially curable illness