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Hemolysis is the presenting complaint in 15% of patients.32,33 If a patient presents with the combination of hemolysis and liver failure, the prognosis is poor because of possible associated renal failure secondary to hemoglobinuria.34,35 The hepatic disease of Wilsons can present as one of the following four clinical subtypes: acute hepatitis, fulminant hepatic failure, chronic active hepatitis, and cirrhosis.36 However, it is also common to diagnose Wilsons disease during investigation of elevated transaminases found on health screening in asymptomatic children