256 Microangiopathic Hemolytic Anemia Following Liver Transplantation: An Overlooked Complication Triggered by Sepsis

Introduction/Objective Microangiopathic hemolytic anemia (MAHA) is an uncommon but critical complication in solid organ transplant recipients. Its recognition is often delayed due to overlapping symptoms with other post-transplant conditions. This case underscores the importance of hematologic surveillance and timely intervention. Methods/Case Report A 35-year-old male with a recent liver transplant presented with fever, abdominal discomfort, and dyspnea. On admission to the ICU, he was in septic shock. Initial labs revealed hemoglobin of 5.5 g/dL, platelets of 20 × 109L, elevated LDH, and peripheral smear findings of schistocytes and nucleated RBCs. Blood cultures grew klebsiella species. Despite appropriate antibiotics and transfusion support, cytopenias worsened. MAHA was suspected and therapeutic plasma exchange was initiated on day five. Results Following plasma exchange, the patient’s hemoglobin and platelet counts improved significantly, along with stabilization of renal and liver function. He was subsequently discharged from the ICU in stable condition. Conclusion This case illustrates the diagnostic challenge of MAHA in post-transplant patients with sepsis. Early detection through peripheral smear review and timely plasma exchange can be life-saving.