A 45-Year-Old Man Comes to the Emergency Department Due to Epigastric

question 90

Multiple Choice

A 45-year-old man comes to the emergency department due to epigastric abdominal pain and fatigue.  He has had similar episodes of pain in the past.  Temperature is 37.1 C (98.8 F) , blood pressure is 128/69 mm Hg, pulse is 92/min, and respirations are 16/min.  Physical examination shows mild epigastric tenderness and hepatomegaly.  There is no jaundice or lymphadenopathy.  Laboratory results are as follows: CT scan of the abdomen shows pancreatic calcifications.  Right upper quadrant ultrasound reveals no evidence of gallstones.  Which of the following processes is most likely responsible for this patient's anemia?

• A)Diminished thymidine synthesis
• B)Impaired globin chain synthesis
• C)Impaired pyruvate decarboxylation
• D)Low rate of intracellular transamination reactions
• E)Reduced iron availability for hemoglobin synthesis

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