Hemolytic Anemia in a 5-Year-Old Child

1. Dark urine and fever; markedly reduced RBC count, hemoglobin level, and hematocrit; reticulocytosis on hospital day 1 that resolved by hospital day 3 following transfusion of 5 doses of packed RBCs on day 1 (3 doses) and days 2 (1 dose) and 4 (1 dose); markedly elevated ESR, LD, and bilirubin (total, direct, and indirect) levels; a reduced haptoglobin level; a red and hazy urine containing detectable amounts of protein, ketones, urobilinogen, and a large amount of occult blood, along with microscopic findings of a large number of RBCs/hpf; positive antibody findings for Epstein-Barr virus viral capsid antigen IgG antibody (EBV VCA IgG Ab) and EBV nuclear antigen (NA) IgG antibodies; and positive direct antiglobulin test (DAT), using anti-C3 antiserum only, and strongly positive 3cell antibody screen findings at 4°C (Table 1).