A 71 year old Caucasian lady attended A & Every unwell with headache, diarrhoea and vomiting. The only finding on examination was nonspecific abdominal tenderness. Baseline bloods showed WBC 3.7x109/L, Hb 111g/L, PLT 22x109/L, CRP 216mg/L, ALT 77I.U/L, AST 83I.U/L, Bilirubin 27μmol/L, normal renal functions, Total protein 51g/L and Albumin 30g/L. A wide range of differentials including hepatitis, TTP, HUS, infective diarrhoea, sepsis and malignancy were considered. She was admitted under the medical team for conservative management and urgent Haematology review.