A 23 year old woman presented with acute ST Elevation Myocardial Infarction (STEMI) three hours after donating plasma. Her only risk factors were obesity and cigarette smoking. She was found to have ST elevation in the anterior and inferior leads. Coronary angiography revealed extensive left anterior descending (LAD) thrombosis. Coagulopathy workup was negative. We propose that plasmapheresis in a known cigarette smoker led to an acute thrombotic event resulting in a STEMI.