Neuro symptoms are often transient, may not be present in ED
Fever, Anemia,<unk> , Renal, Neuro Symptoms
All features DO NOT need to be present at the same time
Consider diagnosis without the full pentad
Thrombotic thrombocytopenic purpura
Other MAHAs 
Immune thrombocytopenic purpura
ITP
Disseminated intravascular coagulation
Sepsis
Heparin-Induced Thrombocytopenia 
SLE