Thrombotic microangiopathies (TMAs) are a group of rare disorders that can be considered life threatening. The hallmark of this disease is a microangiopathic hemolytic anemia with an associated thrombocytopenia which could be congenital or acquired. Acquired vitamin B12 deficiency is overlooked in developed countries but can mimic a TMA. We report the case of 17-year-old male with malabsorption of vitamin B12 with development of pseudo-TMA. When faced with a clinical presentation of a TMA in a child or an adolescent patient, physicians must be aware of the possibility of vitamin B12 deficiency especially in patients at risk for malabsorption.