Background: Thrombotic microangiopathy is histological term characterized by microangiopathic hemolytic anemia, thrombocytopenia and organ injury. It has a diverse etiology and broad spectrum clinical presentation involving multiple systems. Case Series: Here we present three cases of biopsy proven thrombotic microangiopathy of varied etiology and clinical presentation, who received specific treatment.  Conclusion: Early diagnosis of thrombotic microangiopathy and prompt initiation of specific therapy such as plasmapheresis will decrease morbidity and mortality.