Extrinsic hemolytic normocytic anemia Quiz: Ace Your Exams

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A 77-year-old man presents to the emergency department with fatigue, jaundice, paleness, and difficulty breathing for the past week. He states that the symptoms started suddenly. He denies any recent illnesses, sick contacts, or recent travel. Her past medical history is significant for hypertension, rheumatic fever, hypercholesterolemia, and mitral valve regurgitation. Past surgical history includes a mitral valve replacement 2 months ago.  Current medications include lisinopril, simvastatin, and warfarin. His temperature is 37°C (98.6°F), pulse is 96/min, respirations are 18/min, and blood pressure is 108/66 mmHg. Physical examination shows pallor. Laboratory test findings are shown below:  
A table displays hematologic and blood test results. Values like erythrocyte count, hemoglobin, haptoglobin, LDH, and total bilirubin are outside normal reference ranges.
Which of the following is the most likely cause of this patient’s anemia?  

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