A 23-Year-Old Man Comes to the Emergency Department Due to 4

A 23-year-old man comes to the emergency department due to 4 days of cramping abdominal pain.  He has been feeling weak for the past 2 weeks.  He tried over-the-counter antacids without relief.  He is an industrial laborer with no significant medical history or known allergies.  The patient's parents have hypertension, and his siblings are healthy.  Temperature is 37.1 C (98.8 F) .  Physical examination is unremarkable.  The patient's peripheral blood smear is shown on the image below. Which of the following is the most likely cause of this patient's symptoms?

A) Acute intermittent porphyria
B) Acute leukemia
C) Atrophic gastritis
D) Metal poisoning
E) Non-Hodgkin lymphoma
F) Poor nutrition

Correct Answer:

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