Based on the evidence of excessive red blood cell destruction (elevated indirect bilirubin) and evidence of bone marrow compensatory hyperplasia (elevated reticulocytes, inverted bone marrow granulocyte-red ratio), the diagnosis of hemolytic anemia is certain. A positive direct anti-human globulin test indicates that you have autoantibodies bound to your red blood cells, so it can be inferred that autoantibody-mediated red blood cell destruction is autoimmune hemolytic anemia, but in general, autoimmune hemolytic anemia is based on However, in general, autoimmune hemolytic anemia is mainly caused by extravascular hemolysis (destruction of red blood cells in the spleen, etc.), while the location of your red blood cell destruction is obviously inside the blood vessels, so hemoglobinuria (soy sauce-colored urine) is formed, and the systemic symptoms are heavy. Therefore, I think there may be some sudden trigger that causes this condition to appear. Drug factors cannot be excluded, especially acetaminophen, which has been widely reported to cause intravascular hemolysis. If the drug factor is considered, then the first symptoms of back pain and chills (which can occur in acute intravascular hemolysis) are not symptoms of hemolysis, and combined with the red color of the urine (intravascular hemolysis is usually without visual hematuria), it seems more reasonable to consider surgical conditions such as ureteral stones, which can later lead to hemolysis due to the use of drugs. The current treatment is very effective, if drug factors are considered, we must avoid exposure to similar drugs in the future, and we must seek prompt medical attention when similar symptoms appear, intravascular hemolysis is sometimes very dangerous. Of course, if it is not related to drugs, it is not easy to clarify the cause. Generally, self-funding hemolysis should exclude whether it is combined with other autoimmune diseases such as systemic lupus erythematosus, and whether it is combined with lymphoid tissue proliferative diseases such as lymphoma. Immune related indexes such as anti-nuclear antibody profile, immunoglobulin IgG, IgA and IgM quantification should be tested to exclude autoimmune diseases. Imaging of the whole body lymphatic tissues should be done to exclude lymphatic tissue proliferative lesions, and blood and urine immunofixation electrophoresis should be done to exclude clonal proliferation of lymphatic tissues if possible. Of course, this is not very likely.