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A 24-Year-Old Woman Comes to the Office Due to a Month

question 515

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A 24-year-old woman comes to the office due to a month of progressive exertional dyspnea.  The patient does not have chest pain or palpitations.  She has no chronic medical conditions and takes no medications regularly.  Temperature is 37 C (98.6 F) , blood pressure is 114/68 mm Hg, pulse is 90/min, and respirations are 12/min.  BMI is 23 kg/m2.  Examination shows mucosal pallor and bilateral cervical lymphadenopathy.  Cardiopulmonary auscultation reveals clear lung fields and no murmurs.  Laboratory results are as follows: A 24-year-old woman comes to the office due to a month of progressive exertional dyspnea.  The patient does not have chest pain or palpitations.  She has no chronic medical conditions and takes no medications regularly.  Temperature is 37 C (98.6 F) , blood pressure is 114/68 mm Hg, pulse is 90/min, and respirations are 12/min.  BMI is 23 kg/m<sup>2</sup>.  Examination shows mucosal pallor and bilateral cervical lymphadenopathy.  Cardiopulmonary auscultation reveals clear lung fields and no murmurs.  Laboratory results are as follows:   Chest x-ray reveals significant bilateral mediastinal lymphadenopathy.  What is the most likely cause of this patient's anemia? A) Immune-mediated hemolysis B) Increased inflammatory cytokines C) Increased iron recycling by macrophages D) Intratumor hemorrhage E) Thrombotic microangiopathy Chest x-ray reveals significant bilateral mediastinal lymphadenopathy.  What is the most likely cause of this patient's anemia?

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