An 8-Year-Old Boy Is Brought to the Office for Evaluation

An 8-year-old boy is brought to the office for evaluation of bilateral leg and back pain.  His pain started yesterday and has gradually worsened.  He has had no relief with ibuprofen, acetaminophen, and warm packs.  The patient's medical history is notable for sickle cell disease, and he has had 5 prior hospitalizations for similar pain episodes in his back and legs.  Hydroxyurea has been prescribed, but the prescription has not been filled due to lack of insurance.  Temperature is 37.2 C (99 F) , blood pressure is 110/70 mm Hg, pulse is 132/min, and respirations are 20/min.  Physical examination shows an uncomfortable-appearing boy with conjunctival pallor.  Palpation of the bilateral legs and back shows tenderness, although no erythema or swelling is noted.  Laboratory results are as follows: What finding is most likely to be present on this patient's peripheral smear?

A) Basophilic stippling
B) Bite cells
C) Heinz bodies
D) Helmet cells
E) Howell-Jolly bodies

Correct Answer:

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