A 10-Week-Old Boy Is Brought to the Clinic for a Follow-Up

question 620

Multiple Choice

A 10-week-old boy is brought to the clinic for a follow-up visit.  He was evaluated in the emergency department 2 weeks ago due to fever.  He was well appearing.  Laboratory testing revealed leukopenia and anemia.  He received empiric antibiotics and was discharged with outpatient follow-up.  Bacterial cultures were negative, and his fever resolved.  The mother says the patient has been doing well and has continued to normally take soy-based formula feeds.  He was born at term, has no other medical conditions, and takes no medications.  Temperature is 37 C (98.6 F) , blood pressure is 96/62 mm Hg, pulse is 120/min, and respirations are 30/min.  Pulse oximetry is 99% on room air.  The patient is awake.  Physical examination shows no abnormalities.  Laboratory results are as follows: Which of the following is the most likely cause of this patient's anemia?

• A)Decreased dietary iron intake
• B)Hemoglobinopathy
• C)Intravascular hemolysis
• D)Reduced erythropoietin production

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