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A 7 3-year-old man with anemia requiring transfusions for the past 3 mon ths presen ts for further evaluation . Leukocyte count is LJ ,900/ Jil, hemoglobin 7.9 g/dl, MCV 99 fl. platelet count 1 76,000/ Jil, and reticu locyte production index 0. 1 %. LDH is 1 82 U/L. On physical exam, he has no hepatosplenomegaly or lymphadenopathy. The peripheral blood smear is shown below.
First-line therapy for PRCA includes all of the following except:
- Rituximab
- Cyclosporine
- Cyclophosphamide plus corticosteroids
- Corticosteroids alone
Medicine
A. Rituximab is considered for relapsed or resistant disease, along with several other agents, including intravenous immunoglobulin, azathioprine, antithymocyte globulin and alemtuzumab. Cor-ticosteroids alone or in combination with cyclosporine or cyclophosphamide are first-line therapies.
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