ADAMTS13 and hyperinsulinemic hypoglycemia, familial, 4: Therefore, given thepersistence of laboratory findings with a microangiopathic hemolytic anemia profile(Table 2, day-3) and a PLASMIC score witha high probability of severe ADAMTS13 deficiency, probable acquired thromboticthrombocytopenic purpura was considered, starting management with plasma exchangeand high-dose steroids prior to recording ADAMTS13 levels.