A 7-Week-Old Boy Is Brought to the Office for Routine

A 7-week-old boy is brought to the office for routine follow-up after being discharged from the neonatal intensive care unit (NICU) .  He was born at 32 weeks gestation, and the pregnancy was complicated only by preterm labor.  After delivery, the patient received a short course of prophylactic antibiotics while awaiting blood culture results, which were negative for bacterial growth.  Other than difficulty feeding, he had no other issues in the NICU.  By age 6 weeks, the patient was taking a normal volume of fortified preterm formula and gaining weight appropriately.  He was discharged from the hospital last week and has continued taking formula and ferrous sulfate.  Temperature is 37.5 (99.5 F) , pulse is 150/min, and respirations are 30/min.  Pulse oximetry is 98% on room air.  The patient is awake and alert.  Cardiac auscultation reveals a 2/6 systolic flow murmur with no gallop.  The abdomen is soft with no organomegaly.  Laboratory results are as follows: The peripheral smear shows normocytic, normochromic red blood cells.  Which of the following is the most likely underlying cause of this patient's laboratory findings?

A) Abnormal hemoglobin subunit ratio
B) Antibiotic-mediated immune hemolysis
C) Impaired erythropoietin production
D) Inadequate iron dosage
E) Iron sequestration in macrophages

Correct Answer:

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