Pre-course Quiz-Anemia

  A 2-year-old child is seen for routine wellness visit. Parents have no complaints, except that he is a picky eater. Physical exam is normal except for pallor. Complete blood count (CBC) reveals low hemoglobin of 9.0 g/dL, platelets increased to 600 K/uL, and normal WBC. RBC is normal, MCV is low at 61 fL, and RDW is elevated at 20%. Which of the following is most likely to reveal the diagnosis? 

The 2-month-old term infant sister of the child in the previous vignette is also seen for routine wellness visit, and parents request point-of-care hemoglobin out of concern that she might be anemic as well. Her hemoglobin is also 9.0 g/dL. Physical exam reveals a well nourished and developmentally appropriate infant who is growing at the 25%ile. What is the most appropriate next step in management?

A 5-year-old boy with severe short gut syndrome and resulting TPN dependence presents to the emergency department with pallor and fatigue. CBC reveals hemoglobin 8.0 g/dL, WBC 3.0 K/uL, and platelets 135 K/uL. MCV is 94 fL. Peripheral blood smear reveals hyperlobated neutrophils. Which of the following is most likely to reveal the diagnosis? 

A 9-year-old previously healthy boy presents to the emergency department with jaundice and fatigue. CBC shows hemoglobin 6.5 g/dL with normal WBC and platelets. Reticulocyte count is 200 K/uL. Total bilirubin is elevated, but liver enzymes and remainder of metabolic panel are normal. DAT is positive. Physical exam is notable for hepatosplenomegaly in addition to jaundice and scleral icterus. The child is also tachycardic and tired appearing. What is the most likely diagnosis?