<prompt> A 25-year-old pregnant lady presents with thrombocytopenia Platelet count 50,000 and fragmented RBCs in peripheral smear. Which of the following is the least likely differential diagnosis?Thrombotic Thrombocytopenic Purpura TTPDisseminated Intravascular Coagulation DICHELLP syndromeEvans syndrome  <response>: Answer is D Evans syndrome Evans syndrome is not a microangiopathic hemolytic condition and does not present with fragmented RBCs in the peripheral smear. Presence offragmented RBCs in the peripheral smear suggests the diagnosis of a micro-angiopathic process Microangiopathic Hemolytic Anemia. The fragmentation of RBCs is caused by fibrin deposits in small blood vessels, which cause mechanical hemolysis. Patients with microangiopathic hemolytic anemias are usually thrombocytopenic due to consumption of Platelets. Microangiopathic Hemolytic anemia fragmented RBC and Thrombocytopenia are typically seen in TTP, HUS, DIC and HELLP syndrome besides several other conditions. Evans syndrome combination of ITP and Autoimmune Hemolytic Anemia AIHA Evans Syndrome refers to a combination of Idiopathic Thrombocytopenie Purpura ITP and Autoimmune Hemolytic Anemia AIHA in the absence of an underlying cause disease. The occurence of thrombocytopenia may coincide with episodes of hemolysis or may arise as separate episodes. Evans syndrome is more common in children Evans syndrome tends to be resistanct to management of Warm AIHA or ITP Evans syndrome presents with Thrombocytopenia and Immune Hemolysis. Evans syndrome does not present with microangiopathic features or fragmented RBCs. TTP, DIC and HELLP syndrome all may present with microangiopathic features fragmented RBCs and thrombocvtopenia Microangiopathic Hemolytic Anemias TTP HUS DIC Vasculitis Collagen Vascular Disorders Malignant HypeensionEclampsiaHELLP Disseminated carcinomatosis Metastasis DrugsRadiation Antiphospholipid syndromeNMS Medicine Prosthetic Hea Valves Pathologically Macroangiopathic - Ruhoi s Pathology Patients with microangiopathic hemolytic anemias are usually thrombocytopenic due to consumption of Platelets. 