The direct Coombs test is positive. Wayne has autoimmune hemolytic anemia (AIHA). Or, in words we can understand, his immune system is attacking and destroying his red blood cells (RBC’s) which leads to extreme anemia. He really, really knows the meaning of being exhausted. A positive direct Coombs test can visually indicate that antibodies (and/or compliment proteins) have become bound to the surface of the RBC’s. It is these antibodies and proteins that cause the RBC’s to rupture. Thus the need for blood transfusions. Ok, so that is not a good thing. Here is the good thing. The hemolysis (destruction of Wayne’s RBC’s) lasts about 5-10 days and gradually subsides as his residual incompatible RBC’s are lysed, destroyed and replaced by transfused group O cells, or RBC’s of donor type produced by engrafting stem cells. Further antibody production should stop. It could be a scary 5-10 days, but hey, he is half way there!!!! And of course, we just happen to be in a place that has blood to spare.