 Hemophagocytic syndrome, HPS, is a rare but serious condition that can be caused by a variety of factors including viruses, autoimmune diseases, and certain types of cancer. It is characterized by massive infiltration of bone marrow by activated macrophages, which leads to pancytopenia and thrombotic microangiopathy, TMA. This condition can be complicated further when it occurs alongside another condition known as thrombotic microangiopathy, TMA. This review discusses a case study of a patient who was diagnosed with both HPS and TMA and how they were treated successfully with intravenous immunoglobulin, IVIG, and plasma Pharisees. This article was authored by Hader Ali Esmaili, Almira Mostafidi, Bahari Maramouz, and others.