eng Science and Education Publishing American Journal of Medical Case Reports 2374-216X 2015-10-15 3 11 372 373 10.12691/ajmcr-3-11-6 AJMCR20153116 article Ilknur Nizam 1 Mehmet Ali Erkurt 1 Ilhami Berber 1 Mustafa Koroglu 2 Emin Kaya 2 Irfan Kuku 2 Nese Karadag 3 Hematology Department, Inonu University Turgut Ozal Medical Center, Malatya, Turkey Karabuk University Karabuk Education and Research Hospital, Karabuk, Turkey Pathology Department, Inonu University Turgut Ozal Medical Center, Malatya, Turkey We report a case of thrombotic thrombocytopenic purpura (TTP) which was explored to be the clinical presentation of carcinoma. Plasma exchange therapy failed to respond for the patient, so bone marrow aspiration and biopsy were performed to find out the reason of microangiopathic hemolytic anemia. Bone marrow examination revealed non hematopoetic cell infiltration and myelonecrosis. Carcinoma metastasis was demonstrated at bone marrow trephine biopsy. The primary tumor was found at small bowel after scanning for the source of tumor by computerized tomography. http://pubs.sciepub.com/ajmcr/3/11/6/ajmcr-3-11-6.pdf TTP malignancy plasmapheresis