Tehran University of Medical Sciences International Journal of Hematology-Oncology and Stem Cell Research 2008-2207 19 1 2025 01 21 75 80 Saeid Anvari 1)Department of Hematology and Medical Oncology, Guilan University of Medical Sciences, Rasht, Iran 2)Regenerative Medicine, Organ Procurement and Transplantation Multi-Disciplinary Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran Amirhossein Larijani 1)Regenerative Medicine, Organ Procurement and Transplantation Multi-Disciplinary Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran 2)Student Research Committee, Guilan University of Medical Sciences, Rasht, Iran Nasim Ghorbannejad Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran 2023 12 25 2024 08 12 Thrombotic thrombocytopenic purpura (TTP) is a medical condition characterized by a decreased activity of the ADAMTS13 protease,  responsible for cleaving the von Willebrand factor. It contributes to thrombotic microangiopathy. In this report, we described a case of TTP  followed by significant adverse effects during therapeutic plasma exchange (TPE) treatment. The patient received TPE with a time interval from plasma transfusion. A 30-year-old female was evaluated for headaches and bruises on her arms and legs. Laboratory testing revealed thrombocytopenia and anemia. The identification of thrombocytopenia with severe schistocytosis was verified by the analysis of a peripheral blood smear. After confirming a diagnosis of TTP, TPE was performed as therapy. To avoid the complications arising during the previous TPE sessions, we conducted plasma exchange with albumin followed by FFP injection, with a six-hour interval between them. This strategy successfully alleviated the patient's symptoms. Therapeutic plasma exchange (TPE) with a time interval from plasma transfusion can be successfully used in patients with severe TPE complications. https://ijhoscr.tums.ac.ir/index.php/ijhoscr/article/view/2145 https://ijhoscr.tums.ac.ir/index.php/ijhoscr/article/download/2145/1073