Intrinsic hemolytic normocytic anemia Quiz: Ace Your Exams

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A 29 year-old African-American man comes to the emergency department complaining of fatigue, jaundice, back pain, and dark urine for the last 5 days. He recently returned from a trip to Kenya, during which time he took malaria prophylaxis medication. The patient’s medical history is non-contributory. However, he states that his maternal uncle had similar symptoms when treated with specific types of antibiotics. Temperature is 37.1°C (98.8°F), pulse is 72/min, respirations are 14/min, and blood pressure is 126/78 mmHg. Physical examination shows scleral icterus. Laboratory tests are obtained, and the results are shown below.  
 
 Laboratory value  Result  Reference Range 
 Hematologic   
 Hemoglobin  8.6 g/dL  13.5-17.5 g/dL 
 Mean corpuscular volume (MCV)   85 fL  80-100 fL 
 Platelet count  190,000/mm3   150,000-400,000/mm3  
 Leukocyte count  10,000/mm3  4,500-11,000/mm3  
 Reticulocyte count   8.5%  0.5-1.5% 
 Haptoglobin  24 mg/dL  41-165 mg/dL 
   
Which of the following is most likely seen on this patient’s peripheral blood smear? 

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