A 14-year-old girl with no past medical
A 14-year-old girl with no past medical history presents to the emergency department after suffering a brief syncopal episode in her bathroom at home. Her A 15-year-old girl with no past medical history presents to the emergency department after suffering a brief syncopal episode in her bathroom at home. her history is remarkable for an influenza-like febrile illness last month, followed by lingering fatigue and daytime sleepiness. There is no personal or family history of symptoms like these. She has normal vital signs apart from heart rate of 112 beats per minute. Physical exam reveals an awake and alert girl lying in bed, who answers questions appropriately. She has marked facial, conjunctival, and gingival pallor, and scleral icterus. Cardiovascular exam reveals a grade II/ VI systolic ejection murmur, capillary refill of less than 3 seconds, and 2 + peripheral pulses in all extremities. Laboratory evaluation includes hemoglobin 5.3 g/ dL, white blood cell count 11.9 × 103/ mm3, and platelets 502 × 103/ mm3. White cell differential includes 30% neutrophils and 60% lymphocytes. Evaluation of the blood smear reveals normocytosis and normochromia, occasional spherocytes, and no schistocytes. Serum total bilirubin and lactate dehydrogenase (LDH) are both elevated. Which of the following evaluations is most likely to yield this patient’s diagnosis? glucose-6-phosphate dehydrogenase (G6PD) enzyme activity direct antiglobin (Coombs) test ferritin, serum iron, total iron binding capacity WRONG ANSWER erythrocyte osmotic fragility test bone marrow aspiration and biopsy 4 SCIENCE HEALTH SCIENCE NURSING
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