Case Quizzes
Test your knowledge with ASPHO’s Case Quizzes on a variety of pediatric hematology/oncology topics. Over 20 quizzes are available with new quizzes added every other month and highlighted in ASPHO eNews.
Each case quiz includes a description of the case, multiple answer options, an explanation of the correct answer, and learning points on the topic. Case quizzes are developed by ASPHO volunteers, searchable by topic and available at no cost.
October 2026 Case Quiz
A 20-year-old with Fatigue and Headaches
Clinical Presentation
A 20-year-old previously healthy patient presents with 3 months of progressive fatigue, headaches, and decreased exercise tolerance. She noticed that her urine is occasionally “tea-colored,” particularly in the morning. She has had intermittent abdominal discomfort but no fevers, weight loss, or overt bleeding.
On examination, she is pale but otherwise well appearing. There is no jaundice, lymphadenopathy, or hepatosplenomegaly. Her neurologic examination is normal.
Initial laboratory studies show the following:
| Test | Result |
| Hemoglobin | 7.8 g/dL |
| MCV | 91 fL |
| WBC | 3.1 × 10⁹/L |
| ANC | 1.4 × 10⁹/L |
| Platelets | 118 × 10⁹/L |
| Reticulocytes | 7.2% |
| LDH | 2,150 U/L |
| Total bilirubin | 3.1 mg/dL |
| Haptoglobin | Undetectable |
| Creatinine | 0.9 mg/dL |
Direct antiglobulin test Negative
Peripheral smear shows polychromasia without significant schistocytosis or spherocytosis.
What is the most likely diagnosis?
Eleny Romanos-Sirakis, MD
Northwell/Staten Island University Hospital
Staten Island, NY