Laboratory findings showed hemoglobin of 7 g/dL, mean corpuscular volume (MCV) of 103.8 fL, platelets of 3 x 10^3/μL, bilirubin of 5 mg/dL, creatinine of 1.03 mg/dL, aspartate aminotransferase (AST) of 45 U/L, alanine aminotransferase (ALT) of 73 U/L, haptoglobin <8 mg/dL, elevated reticulocyte count at 15.3%, lactate dehydrogenase (LDH) of 498 U/L, and schistocytes on peripheral smear (Figure 1) were highly concerning for microangiopathic hemolytic anemia. The gene discussed is GPT; the disease is congenital thrombotic thrombocytopenic purpura.