Thrombotic microangiopathy (TMA) is a medical emergency. Recognizing and identifying the pathophysiological mechanism is crucial for quickly initiating appropriate treatment and reducing morbidity and mortality. Thrombotic thrombocytopenic purpura (TTP) should systematically be considered among the causes of TMA. Two scores (French and PLASMIC) can be used upon patient admission. If the probability of TTP is high, the treatment should be initiated without waiting for diagnostic confirmation. This article presents several cases of TMA and their respective management.