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Vitamin B12 and folate levels: These tests assess for megaloblastic anemias caused by deficiencies in DNA synthesis, not for blood loss or hemolysis. They help identify macrocytic anemia rather than anemia related to red blood cell destruction or bleeding.

Ferritin: Ferritin measures stored iron levels and helps diagnose iron deficiency anemia but does not directly assess ongoing blood loss or red cell destruction. Low ferritin suggests depleted iron stores, not increased destruction of red blood cells.

Hemoglobin electrophoresis: This test identifies abnormal hemoglobin variants, such as those seen in sickle cell disease or thalassemia. It is useful for diagnosing genetic disorders affecting hemoglobin structure, not for detecting blood loss or hemolysis.

CLL: Chronic lymphocytic leukemia involves the overproduction of abnormal B lymphocytes, leading to immune dysfunction and potential cytopenias. However, platelet destruction in CLL is secondary to bone marrow suppression rather than immune-mediated destruction.

ALL: Acute lymphoblastic leukemia is characterized by excessive proliferation of immature lymphoid cells in the bone marrow, which suppresses normal hematopoiesis. Thrombocytopenia in ALL results from decreased platelet production, not immune-mediated destruction.

AML: Acute myeloid leukemia causes bone marrow infiltration by immature myeloid cells, impairing platelet production. Like ALL, thrombocytopenia here is due to marrow failure, not immune mechanisms targeting platelets.

Anesthesiologist: The anesthesiologist is primarily responsible for evaluating a patient’s readiness for anesthesia and managing perioperative care. They typically become involved after the initial diagnosis and treatment plan have been established.

Surgeon: The surgeon becomes involved once a surgical condition is suspected or confirmed, focusing on operative intervention and related diagnostics. They usually rely on initial findings and referrals made by the primary care provider.

Pulmonologist: A pulmonologist specializes in diagnosing and treating respiratory diseases. They are typically consulted after the PCP’s initial work-up identifies findings suggestive of a pulmonary condition that requires specialized evaluation.

CLL: Chronic lymphocytic leukemia typically affects older adults rather than children or adolescents. It presents with gradual onset of fatigue, lymphadenopathy, and recurrent infections, not acute symptoms like frequent nosebleeds or severe weakness as seen in Jonathan’s case.

AML: Acute myeloid leukemia commonly occurs in adults and is characterized by bone marrow failure leading to anemia, infection, and bleeding. While some symptoms overlap, AML is less common in pediatric patients compared to acute lymphoblastic leukemia.

ITP: Immune thrombocytopenic purpura causes isolated thrombocytopenia leading to nosebleeds and bruising, but it does not typically cause anemia, leukocyte abnormalities, or systemic symptoms such as weakness and shortness of breath due to pancytopenia.

Gastritis: While chronic gastritis can contribute to iron deficiency through occult bleeding, it is not the primary concern requiring urgent exclusion in postmenopausal women or older adults with IDA. Further investigation for more serious causes is often prioritized.

HIV: HIV infection can lead to anemia due to chronic disease or medication effects, but it is not a leading cause of isolated iron-deficiency anemia. Testing for HIV is appropriate when risk factors exist, but it is not routinely ordered solely for IDA evaluation.

Stroke: Stroke is unrelated to the pathophysiology of iron-deficiency anemia. While anemia can exacerbate cerebral hypoxia during a stroke, it is not a diagnostic focus or contributing factor in evaluating IDA etiology.

Central nervous system (CNS) prophylaxis: This therapy specifically targets leukemic cells that may infiltrate the brain and spinal cord. It is used to prevent CNS relapse but does not address residual systemic leukemic cells throughout the body.

Induction remission: Induction therapy is the first phase of treatment designed to destroy most leukemic cells and achieve remission. However, it may leave behind microscopic residual disease, necessitating additional therapy for complete eradication.

Maintenance therapy: Maintenance therapy involves administering lower doses of chemotherapy over a prolonged period to prevent recurrence. It sustains remission rather than eliminating residual disease that remains after initial intensive treatment.