Patient is a 4-month-old female with 4 days of emesis. Parents brought her in for evaluation because baby was looking "more pale."

On exam, she was awake, alert, without distress, tracking and following past midline, pale, slightly jaundiced. Her conjunctiva were clear. She had moist mucus membranes. Her lungs were clear without increased work of breathing. Heart rate regular rate and rhythm, 2/6 systolic murmur consistent with flow murmur from anemia. She had no palpable spleen or liver. She had no bruising.

Labs revealed WBC 25x 103/mL Hemoglobin 5.1g/dL, platelets 151x103/mL , reticulocyte count >23%. She was then admitted to the hospital. Take the quiz.

Melanie Villanueva, DO
Nazia Tabassum Iqbal, MD
Mukta Sharma, MD
Children's Mercy Hospital, Kansas City, MO

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