A positive DAT is interpreted only once haemolysis is established. The workup first confirms haemolysis with LDH, haptoglobin, bilirubin, reticulocytes and the smear. Here LDH and reticulocytes are normal, so there is no evidence of haemolysis and this is not AIHA needing treatment. The next step is to look for other causes of the anaemia (e.g. ferritin, smear), which are common in end-stage liver disease.

• Prednisone, rituximab and mycophenolate are AIHA treatments and are not indicated without haemolysis.