Great progress has been made in our understanding of thrombotic thrombocytopenic purpura and hemolytic uremic syndrome since Moschowitz first described this entity in 1925. This review provides a contemporary insight into the pathophysiology, diagnosis, and classification of these disorders in both adults and children. Lessons learned from major worldwide registry data and disease epidemics, including the 2011 German outbreak, are discussed with recommendations for management of specific clinical conditions based on available evidence, including the role of plasma exchange, rituximab, and eculizumab.