A 24-year-old woman presented for evaluation of tea-colored urine noticed intermittently over the past five days. Her last menstrual cycle was two weeks ago, and they have been occurring regularly. There is no history of renal stones, NSAID abuse, weight loss, night sweats, fever, melena, or hemoptysis. Her vital signs were unremarkable.
On initial evaluation, CBC, urinalysis, and renal ultrasound were normal and urine pregnancy test was negative. A few days later, she developed jaundice with abdominal pain. Repeat testing at that time showed the following: WBC count 3600/mm3 Hemoglobin 4 g/dl Platelet count 189,000/ mm3 MCV 75 fl RDW 28 Reticulocyte count 10.9 percent (N.V.= 0.5-2.3%) Total serum bilirubin 7.5 mg/dl (N.V.= 0.10-1.2 mg/dl) Indirect bilirubin 5.5 mg/dl (N.V.= 0.10-1.0 mg/dl) AST 213 U/L serum LDH 1500 U/L (nv= 259-613) Serum haptoglobin & lt;10 mg/dL Direct Coomb test…
