Step 2

Hematology 4

A 38-year-old man presents to the emergency department with a complaint of dark urine, weakness, and back pain for 2 days. Prior to onset of symptoms, the patient was seen by his primary care physician for a rash with associated sensory loss. He was prescribed medication that he has been taking for the past 4 days. He denies headache, fever, chills, or nausea. Past medical history is noncontributory. Vital signs are temperature 36° C (98.° F), blood pressure 122/76 mmHg, pulse 68 beats/min, and respirations 18/min. Body mass index (BMI) is 25 kg/m2. Physical examination reveals conjunctival pallor. The rest of his exam is unremarkable. Lab values are as follows:

  • Hemoglobin (blood): 7.9 g/dL
  • Hematocrit: 24%
  • Reticulocyte count: 5%
  • Platelet count: 140,000/mm^3
  • Leukocyte count: 10,900/mm^3

Which of the following is the next best step in management of this patient?

  • A) Admit to hospital for observation
  • B) CT scan of the abdomen and pelvis
  • C) Discontinue the new medication
  • D) Emergent transfusion with packed red blood cells
  • E) Prescribe broad-spectrum antibiotics


Ria Patel


Dr. Ted O'Connell