A man in his early 20s ap...

A man in his early 20s appeared with painless jaundice, tiredness, and shortness of breath that had only been present for one day. He said his stools had not changed, and his urine was black. He had a complicated medical history that included a liver transplant recommended for PSC in 2016, a prior ITP treated with rituximab also in 2016, and a recent diagnosis of Crohn's disease with terminal ileal involvement patchy inflammation throughout the colon discovered by colonoscopy. On inspection, he showed clear signs of jaundice, including scleral icterus, pallor, and pale conjunctivae. He could feel his spleen 4 cm below the diaphragm. At presentation, haemoglobin was 66 g/L; 2 1/2 hours later, it was 52 g/L. Neutrophils made up 8.4109/L of the white blood cell count, which was 13.7109/L. The average corpuscular volume was 108 fL, and 6% of the cells were hypochromic. Reticulocyte percentage was high at 27.4%, indicating regenerative anaemia. Haptoglobin was low at 0.08 g/L, and LDH was elevated to 881 IU/L, both of which were suggestive of hemolysis. At 1 mol/L, conjugated bilirubin was normal. D-dimer was dramatically increased to 1308 ng/mL. Spherocytes, stomatocytes, and polychromasia were detected in the blood film. Two units of red blood cells made up the first dosage, followed by an increase of 82 g/L. After speaking with his liver transplant primary team, he was moved to the care of haematology. He was continued on tacrolimus and was treated with steroids.