Introduction: Thrombotic thrombocytopenic purpura (TTP) is a life-threatening disease present with the classic pentad of microangiopathic hemolytic anemia (MAHA), fever, neurologic changes, thrombocytopenia, and renal dysfunction. In a diagnostic dilemma, therapeutic plasma exchange (TPE) choice of lifesaving intervention. Aim: Aim to assess the efficacy of TPE in a suspected case of postpartum TTP Material and methods: 27 years old Female was admitted in an emergency, on Day 8th after a lower segment caesarian section (LSCS) with unresponsive behavior for 3 days and with TTP. She was normal 32 days back with her 2nd, 7-month pregnancy. Ultrasonography (USG) showed an umbilical cord around the neck of the baby. On the 5th postoperative day, shifted to emergency with fever, generalized anasarca, gastrointestinal tract (GI) bleeding, low platelet count, and low Hb, with a poor Glasgow coma scale (GCS) of 6. On the bases of serum urea and serum creatinine presented acute kidney injury with encephalopathy. At emergency, she was unresponsive to mechanical ventilation and supportive treatment, hence therapeutic plasma exchange was performed. Results: After 8 TPE cycles patient presented with an improved hematological and renal profile with good GCS. Conclusion: TPE is helpful and lifesaving for suspected TTP patients with AKI.