IC and TTP are two causes of thrombocytopenia that require timely diagnosis and different treatments. Both conditions can be difficult to recognize as clinical presentations vary and current diagnostic criteria lack specificity. Although clinical presentation and laboratory data often lead to the correct diagnosis, equivocal results can often preclude finding a clear etiology. This is the case of a 77 year old female with PMH of spinal degeneration s/p multiple spinal surgeries, hypertension, and hyperlipidemia, who presented to the surgical ICU s/p T9-ileum posterior fusion transverse osteotomy, L1-L2 transforaminal lumbar interbody fusion, and T11-T12 posterior laminectomy. Our case demonstrates the difficulties in confirming a diagnosis with sensitive but nonspecific criteria. TTP and DIC share similar characteristics, but missing a timely diagnosis of TTP can prove fatal for the patient without treatment.