01-21-2012, 01:13 PM
34. A 10-year-old girl has had fatigue and pallor for 3 weeks. Six weeks ago, she underwent aortic valve replacement with a mechanical prosthesis. She is receiving digoxin therapy. Her temperature is 37°C (98.6°F), blood pressure is 100/60 mm Hg, pulse is 115/min, and respirations are 24/min. A grade 2/6, systolic ejection murmur is heard along the left sternal border, and a grade 2/6, decrescendo diastolic murmur is heard along the left sternal border to the cardiac apex. The liver and spleen are palpable. Her hemoglobin level is 4.6 g/dL. A blood smear shows schistocytes. Which of the following is the most likely cause of the anemia?
A) Autoimmune hemolytic anemia
В
Digoxin-induced hemolytic anemia
С Glucose 6-phosphate dehydrogenase deficiency О D) Hemolytic-uremic syndrome
D)Hemolytic-uremic syndrome
E) Peri prosthetic valve leak
A) Autoimmune hemolytic anemia
В
Digoxin-induced hemolytic anemiaС
Glucose 6-phosphate dehydrogenase deficiency О D) Hemolytic-uremic syndromeD)Hemolytic-uremic syndrome
E) Peri prosthetic valve leak