On the second day of hospitalization, the patient became symptomatic secondary to tissue hypoxia. Physical examination revealed tachycardia (120 to 130 beats/min), tachypnea (20 to 26 breaths/min), mild hypotension (100/53 mm Hg), temperature of 37.4°C, and a markedly depressed level of consciousness. CBC count showed hemoglobin of 3.3 g/dL, and blood chemistry revealed a lactate level of 6.2 mg/dL. At this time, the patient was urgently admitted to the liver transplant ICU. She was intubated and placed on mechanical ventilation (fraction of inspired oxygen, 100%.) In order to decrease oxygen uptake (V̇o2), the patient was sedated and paralyzed (with propofol and vecuronium) and actively cooled with a cooling blanket and cooled IV crystalloids. In addition, the patient received 1 g of methylprednisolone IV. Secondary to these interventions, the patient’s pulse rate decreased to the upper 80s, temperature decreased to 33.8°C, BP decreased slightly to 90/53 mm Hg, and lactate level decreased to 1.0 mg/dL. The patient was then slowly transfused with 1 U of blood, crossed-matched as closely as possible, when it became available later in the day. The hemoglobin level subsequently increased to 3.9 g/dL, and LDH further increased to 1,058 IU/L. Given the severity of the AIHA and the paucity of blood available for transfusion, it was decided that the patient would likely benefit from splenic embolization.