A diagnostic dilemma occurred when thrombotic microangiopathy developed during 
pregnancy. The diagnostic criteria of thrombotic microangiopathy include 
thrombocytopenia (platelets <100) and microangiopathic haemolytic anaemia 
(including thrombotic thrombocytopenic purpura and haemolytic-uraemic syndrome). 
An urgent interdisciplinary approach is required to treat thrombotic 
microangiopathy in pregnancy to differentiate between thrombotic microangiopathy 
and HELLP syndrome (haemolysis, elevated liver enzymes, low platelets).1 This 
case presented with the pentad of thrombotic thrombocytopenic purpura: severe 
thrombocytopenia (platelets 9 × 109/L), microangiopathic haemolytic anaemia 
(reticular count 245 × 109/L (20-110)), LDH >5000 U/L (<425)), neurological 
abnormalities (Glasgow Coma Scale 10/15), renal failure (creatinine 140 µmol/L 
(<97)), fever (37.7℃). A Disintegrin And Metalloproteinase with a Thrombospondin 
type 1 motif, member 13 (ADAMTS13) activity of less than 5% and anti-ADAMTS13 
antibodies retrospectively confirmed the diagnosis of acquired idiopathic 
thrombotic thrombocytopenic purpura in pregnancy. The immediate management in 
the Emergency Department with an interdisciplinary team of Consultant 
Nephrologists, Intensivists, Haematologists and Obstetricians facilitated prompt 
diagnosis resulting in immediate plasma exchange (PEX) and coordination of 
semi-elective delivery of the foetus.