A 59-year-old woman had a 17.5-year history of dialysis and thrombocytopenia. She underwent total hip joint replacement due to left-side amyloid malumcoxae on July 8, 1992. After the operation, she developed a giant hematoma, drug-induced liver dysfunction, and disseminated intravascular coagulation (DIC). During the treatment of these complications, she had episodes of fever, jaundice, confusion, and anemia. In addition, her thrombocytopenia become worse. She was strongly suspected to have developed thrombotic thrombocytopenic purpura (TTP) and underwent plasmapheresis starting August 31, 1992. However, she died in September.Bone marrow aspiration showed hypoplasia of megakaryocytes, erythroblasts, and leukocytes. There have been few reports of dialysis patients who developed TTP and bone marrow findings have not previously been documented. Our patient had idiopathic thrombocytopenic purpura preoperatively, and her TTP may be attributable to operative invasion, giant hematoma, DIC, or liver dysfunction.