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ASPHO April 2017 Case Quiz

Page 1 Questions

A Ten-Year-Old with Anemia, Fever, and Weight Loss.
Erika Friehling, MD, Assistant Professor of Pediatrics, Children's Hospital of Pittsburgh of UPMC
 

A 10-year-old previously healthy girl presents to hematology clinic because of persistent anemia. Her primary care physician performed routine blood work, which showed a hemoglobin of 8.5 g/dl. Iron supplementation was prescribed at a dose of 5 mg elemental iron/kg/day, and she was compliant with taking the medication. Repeat blood work done 2 months later showed worsening anemia, prompting a hematology evaluation. On review of systems, she reports weight loss (4 pounds over 3 months), intermittent fevers (101F–102F) for the last couple of months, and occasional epigastric abdominal pain. She denies hematochezia, diarrhea, vomiting, or hematuria. Her exam is significant for pallor, but is otherwise unremarkable—specifically, there was no hepatosplenomegaly or palpable lymphadenopathy.

1. The most likely etiology of the anemia is