A 33-year-old Romanian woman presented with a one day history of “cola-coloured” urine with associated fevers. She reported generalised malaise, arthralgia and reduced appetite for 24 h. The patient had a history of beta-thalassemia trait. She was not taking any regularly prescribed or over-the-counter medications and had no known allergies. Scleral icterus was noted on examination. There was no pathological lymphadenopathy or organomegaly. Her laboratory investigations were as follows; haemoglobin 3.6 g/dL, mean corpuscular volume 99.2 fl, platelets 219 × 109/L, white cell count 13.4 × 109/L, reticulocytes 351 × 109/L, direct antiglobulin test – negative, total bilirubin 88 umol/L, C-reactive protein 100 mg/L, lactate dehydrogenase 1250 u/L (upper limit 240 u/L) and haptoglobin 0.41 umol/L.
