Delayed presentation of thrombotic thrombocytopenic purpura (TTP). We report a female patient presenting with a headache and dizziness for two weeks, her past medical history is notable for epistaxis otherwise unremarkable. On examination she was pale with a tinge of jaundice. She was vitally stable, other systems were unremarkable. A peripheral blood smear showed evidence of microangiopathic haemolytic anaemia (MAHA) and thrombocytopenia. No evidence of organ dysfunction. Plasma exchange and corticosteroids were started with dramatic response. This case illustrates the efficacy of plasmapheresis in late TTP.