Physical examination was notable for jaundice and mild-to-moderate distress secondary to abdominal pain. Vital signs were stable, and the patient was afebrile on initial presentation. Lung fields were clear to auscultation, and heart sounds were normal but tachycardic. Abdominal examination revealed mild distention with diffuse tenderness to palpation but no rebound or guarding. Laboratory studies were remarkable for a WBC count of 6,500/μL with left shift; hemoglobin, 8 g/dL (baseline, 12 g/dL); platelets, 12,000/μL; prothrombin time, 29 s; and international normalized ratio, 2.7. Basic metabolic profile was within normal limits, but aspartate aminotransferase and alanine aminotransferase levels were elevated at 305 U/L and 84 U/L, respectively. Further laboratory evaluation revealed a haptoglobin level < 6 mg/dL, total bilirubin of 8.7 mg/dL (unconjugated, 4.2 mg/dL), and lactate dehydrogenase of 5,539 U/L. Laboratory results at the time of discharge of the previous hospitalization were as follows: hemoglobin, 11.8 g/dL; platelets, 72,000/μL, international normalized ratio, 1.4; total bilirubin, 1.8 mg/dL; and lactate dehydrogenase, 524 U/L. As the laboratory values were suggestive of hemolysis, the peripheral smear was examined for further evaluation.