Approach to anemia (destruction and sequestration) Quiz: Ace Your Exams

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A 28-year-old woman presents to the emergency department with a three-day history of progressive fatigue, confusion, and a rash over her lower extremities. She reports a severe headache and dyspnea. Her past medical history is notable for systemic lupus erythematosus with alopecia and arthritis which has been well-controlled for the past five years with hydroxychloroquine. Temperature is 38.5°C (101.3°F), heart rate is 110/min, blood pressure is 95/55 mm Hg, respiratory rate is 24/min, and oxygen saturation is 94% on room air. Examination reveals pallor and a petechial rash on her legs bilaterally. She has no alopecia and no joint tenderness or swelling. Neurological examination shows no focal deficits, but the patient is confused. Laboratory evaluation is significant for hemoglobin of 6.9 g/dL, platelet count of 25,000/mm3, lactate dehydrogenase (LDH) level of 400 U/L, and schistocytes on peripheral smear. IV fluids are initiated. Which of the following is the best next step in management?  

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