A 28 years’ pregnant woman with 24 weeks’ gestational age referred with petechiae and purpura from previous day without any trauma. She had an occipital headache from last night. Overt petechial and purpuric lesions were seen in the mouth and skin. There was neither hepatosplenomegaly nor lymphadenopathy. She was conscious and oriented. The patient was febrile, anemic and thrombocytopenic with stable vital signs. All liver enzymes were elevated. Coagulation profile was normal. WBCs were normal. RBCs were reduced, and she had polychromatosis. Overt shistocytosis was seen. Platelets were significantly decreased. The first diagnosis was TTP. All necessary laboratory tests were done to rule out the secondary rheumatologic causes of TTP; which all were normal. Coombs tests were negative. ADAMTS 13 Ab was elevated. Fetal ultrasonography was normal.

Treatment started with plasmapheresis and corticosteroid. After treatment, platelets count begins elevated, and LDH decreased. The patient discharged with a good general condition and normal lab tests. She continued her pregnancy until term, and born a normal infant without any complication. She did not have a recurrence of TTP until September 2014.