A patient develops fever, chills, and back pain shortly after starting a blood transfusion. Laboratory tests show an increase in bilirubin and a decrease in haptoglobin levels. Which of the following is the most appropriate diagnostic test to confirm an acute hemolytic transfusion reaction?

A 25-year-old female presents to her primary care provider for evaluation of fatigue which has persisted for the past 6 months. She has tried multiple diets and sleep schedules to improve her condition, but none have succeeded. She has no significant past medical history. She is currently taking a multivitamin daily. Vital signs: T: 98.8°F (37.1°C), BP: 107/58 mmHg, HR: 90/min, RR: 13/min, and oxygen saturation is 98% on room air. Laboratory values are seen below. Hemoglobin: 8 g/dL Hematocrit: 24% MCV: 118 Leukocyte count: 6,500 with normal differentialPlatelet count: 147,000 Physical exam is notable for decreased proprioception in the lower extremities. Which of the following is the most appropriate next step in management to confirm the diagnosis?

A 65-year-old man presents to the hospital with complaints of fatigue, nausea, vomiting, and diarrhea for the past five days. He also states numbness and tingling of the legs, joint pain, and decreased urination that developed around the same time. He was recently diagnosed with non-Hodgkin lymphoma and started on chemotherapy two weeks ago. Vital signs show a blood pressure of 95/65 mm Hg, a pulse of 98/min, a respiratory rate of 19/min, and a temperature of 100˚F. Physical examination reveals a pale and cachectic man. Laboratory investigations reveal serum potassium 6.0 mEq/L (normal: 3.5-5.0 mEq/L), serum creatinine 3.2 mg/dL (normal: 0.6-1.2 mg/dL), serum calcium 7.0 mg/dL (normal: 8.6-10.2 mg/dL), and serum uric acid 9 mg/dL (normal: 2.4-6.5 mg/dL). What could have been done to prevent this condition?

A 59-year-old woman is brought to the emergency department by ambulance complaining of acute onset shortness of breath and a “racing pulse” that began after a 16-hour flight for a business trip. Her past medical history is significant for Type 2 diabetes mellitus and for a hospitalization 2 months ago for a myocardial infarction, during which she received low-molecular-weight heparin following cardiac catheterization. Her current medications include metformin, aspirin, propranolol, and atorvastatin. On arrival, her temperature is 99.1°F (37.3°C), blood pressure is 112/74 mmHg, pulse is 96/min, respirations are 22/min, and oxygen saturation is 88% on room air. A chest radiograph is normal and an EKG shows sinus tachycardia. Lab results are obtained with the following results:Serum:Hemoglobin: 14.0 g/dLLeukocyte count: 6,800Platelet count: 260,000After appropriate imaging is performed, intravenous unfractionated heparin is started for treatment of possible pulmonary embolus and the patient is admitted to the hospital overnight. The next morning, the patient reports she is feeling better. Vital signs: T: 98.9°F (37.1°C),      BP: 118/73 mmHg, HR: 88/min, RR: 15/min, and oxygen saturation is 97% on room air. Repeat lab results are as follows:Serum:Hemoglobin: 13.5 g/dLLeukocyte count: 7,200Platelet count: 118,000Which of the following statements about this condition is correct?

 A 7-year-old boy is brought to his pediatrician by his mother for recent fatigue and intermittent fevers over the past month. She also reports that her son has appeared much paler recently. Vital signs at today’s visit are within normal limits. Physical examination is significant for pallor, petechiae, lymphadenopathy, and hepatosplenomegaly. A complete blood count reveals anemia, thrombocytopenia, and neutropenia. A peripheral blood smear is shown (see image). Bone marrow aspiration reveals 47% lymphoblasts. Which of the following is associated with this patient’s presenting condition?

A 25-year-old female with a recent history of systemic lupus erythematosus (SLE) for which she takes corticosteroids, presents to the emergency department complaining of shortness of breath and dizziness. On examination, she is found to be pale and tachycardic. Laboratory tests reveal the following: WBC: 9,600; Hemoglobin: 7.2 g/dL; Hematocrit: 23%; Platelet count: 530,000; MCV: 70; RDW: 18; Retic count: 2.5%; serum LDH and serum haptoglobin are normal. Which of the following is the most useful clinical intervention to determine the underlying cause of this patient’s anemia?

In a patient diagnosed with essential thrombocythemia and a high risk of thrombosis, which of the following is the most appropriate treatment?

A 61-year-old woman presents to your office complaining of mild fatigue and weight loss over the past 6 months. She states she has felt generally unwell and has had decreased appetite during this time frame. Her temperature is 98.1°F (36.7°C), blood pressure is 122/80 mmHg, pulse is 88/min, respirations are 16/min, and oxygen saturation is 98% on room air. Physical exam reveals splenomegaly and a nontender abdomen. A complete blood count with differential shows the following:Hemoglobin: 10 g/dLHematocrit: 30%Leukocyte count: 166,500Diff: WBC precursors at all stages of maturationPlatelet count: 92,000A bone marrow biopsy is performed. Which of the following translocations is likely to be seen in this patient?

Match each clinical finding with the correct diagnosis.

A 13-year-old female patient with known sickle cell disease presents to the primary pediatrician’s office with chest pain, tachypnea, and fever. This chest x-ray was obtained (see image). What is the most likely diagnosis?