Patient suffered from severe anemia refractory to multiple transfusions along with AMS and lactic acidosis. Liver ultrasound did not show cholecystitis or biliary ductal dilation. CT angiography chest/abdomen/pelvis revealed hepatosplenomegaly but was otherwise unrevealing. Peripheral smear showed evidence of extravascular hemolysis and atypical lymphocytosis without schistocytes. EBV and respiratory viral panel PCR were negative. Total bilirubin peaked at 35 and direct bilirubin peaked at 21 AST and ALT were initially normal but had a delayed peak of 963 and 411 respectively. There was no exam evidence of hepatomegaly or splenomegaly.Her hemoglobin was initially 8.3 and downtrended to a nadir of 2.7 platelets were 147 with a nadir of 7. She had scleral icterus, but no abdominal tenderness or distention. On exam, she had a high-normal temperate of 37.9C, heart rate in the 120s, and normal blood pressure. She had given birth 2 months prior to presentation to a healthy child however, the pregnancy was complicated by severe preeclampsia. Case Presentation: A 34 year-old female with a history of anxiety and depression initially presented to an outside hospital and then was transferred to our facility for jaundice.
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