Snapshot A 24-year-old woman presents to the ED with acute-onset fatigue, fever, and blurry vision. On chart review, it is revealed that she was recently diagnosed with AIDS and was on multiple anti-retroviral medications. On physical exam, her skin is mildly jaundiced. She has multiple purpura over her extremities. Her peripheral smear reveals with schistocytes. Introduction Thrombotic microangiopathy characterized by a pentad login to view 5 more bullets Similar to HUS but with fever and neurologic symptoms Epidemiology Female > male Most commonly in young adults African-Americans ETIOLOGY Pathogenesis login to view 12 more bullets Presentation Symptoms (recall pentad) login to view 13 more bullets Physical exam login to view 5 more bullets STUDIES Complete blood count login to view 2 more bullets Peripheral blood smear login to view 1 more bullet Serum login to view 3 more bullets Normal PT/PTT ↑ bleeding time Differential TTP HUS DIC Other causes of microangiopathic hemolytic anemia: login to view 5 more bullets Treatment` First-line therapy login to view 1 more bullet Anecdotal evidence login to view 3 more bullets Platelet transfusion contraindicated login to view 1 more bullet Complications Permanent neurologic sequelae Chronic kidney disease login to view 1 more bullet Prognosis Remission with plasma exchange in majority of patients Mortality rate 13-15%