A 3-Year-Old Boy Who Recently Emigrated from Ghana Is Brought

A 3-year-old boy who recently emigrated from Ghana is brought to the physician for health care follow up. He has had episodes of pain and swelling in his hands in the past.   His family history is significant for an older brother who died of pneumococcal sepsis at age 5.  His hemoglobin electrophoresis results are consistent with sickle cell disease (hemoglobin SS) .  Further laboratory evaluation shows a mean corpuscular volume of 113 µm³ Which of the following is the most likely cause of this patient's macrocytosis?

A) Extramedullary erythropoiesis
B) Increased folic acid requirement
C) Iron overload
D) Liver disease
E) Myelodysplastic syndrome

Correct Answer:

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