A 49-year-old African-American male presented to the ED with complaint of diarrhea, fever, and myalgia. The patient had traveled to Ghana one week prior to presentation. The CBC was remarkable for a normochromic normocytic anemia (hemoglobin = 11.9g/dl) with marked thrombocytopenia (platelet count = 20K/ul). Total and direct bilirubin and LDH were elevated at 3.3 mg/dL, 1.4 mg/dL, and 629 IU/L, respectively. Haptoglobin was decreased at 6.0 g/dL consistent with hemolytic anemia. The PT and PTT were within normal limits ruling out disseminated intravascular coagulation as the cause of the thrombocytopenia. The peripheral blood smear showed red cell inclusions with ~10% parasitemia.