A 24-year-old African-American man comes to the office after a rapid HIV test was positive at a health fair. Additional laboratory evaluation reveals a HIV viral load of 240,000 copies/mL and a CD4 count of 180 cells/mm³. The patient is given a prescription for antiretroviral therapy. He is also given dapsone for Pneumocystis jiroveci pneumonia prophylaxis due to a history of rash with trimethoprim-sulfamethoxazole. Pneumococcal and influenza vaccines are administered. A few days later, the patient returns to the office due to fatigue, jaundice, and dark urine. Laboratory results now show the following:

Coagulation studies are within normal limits. Peripheral smear reveals red blood cell fragments, microspherocytes, and bite cells. Which of the following is the most likely underlying cause of this patient's symptoms?
A)Abnormal sickling due to medication
B)Disseminated intravascular coagulation
C)Enzyme-deficiency hemolytic anemia
D)Red blood cell cytoskeleton abnormality
E)Vaccine-induced hemolysis

After Initial Stabilization with Intravenous Fluids and Blood Products, the Patient

Multiple Choice

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