158. A 3-year-old girl is brought to the physician because of a 4-day history of irritability, vomiting, decreased urinary frequency and volume, and diarrhea. She visited a local petting zoo with her family 1 week ago. Her temperature is 38°C (100.4°F), pulse is 100/min, respirations are 30/min, and blood pressure is 130/100 mm Hg. Physical examination shows pallor, petechiae over the chest, and mild abdominal tenderness. Laboratory studies show: A) Elastin B) Fibrin Hemoglobin Hematocrit C) Hemosiderin D) IgA E) IgE F) IgG Erythrocyte count Leukocyte count Reticulocyte count Platelet count Serum Urea nitrogen Creatinine Bilirubin, total Direct Indirect Lactate dehydrogenase 5.9 g/dL (N=11-15) 31% (N=28% -45%) 3.1 million/mm³ (N=3.9-5.31) 18,000/mm³ (N=6000-17,500) 4.5% (N=0.5% -1.5%) 52,000/mm³ (N=150,000-400,000) Direct antiglobulin (Coombs) test result is negative. A photomicrograph of a peripheral blood smear is shown. Acetaminophen, amlodipine, and fluid and nutritional support are administered. In addition to thrombi-containing platelet aggregates, which of the following would cause occlusion of small renal vessels in this patient? 210 mg/dL (N=5-18) 1.1 mg/dL (N=0.3-0.7) 2.5 mg/dL (N=0.1-1) 0.2 mg/dL (N=0.0-0.4) 2.3 mg/dL (N=0.1-0.6) 550 U/L (N=120-500)

158. A 3-year-old girl is brought to the physician because of a 4-day history of irritability, vomiting, decreased urinary frequency and volume, and diarrhea. She visited a local petting zoo with her family 1 week ago. Her temperature is 38°C (100.4°F), pulse is 100/min, respirations are 30/min, and blood pressure is 130/100 mm Hg. Physical examination shows pallor, petechiae over the chest, and mild abdominal tenderness. Laboratory studies show: A) Elastin B) Fibrin Hemoglobin Hematocrit C) Hemosiderin D) IgA E) IgE F) IgG Erythrocyte count Leukocyte count Reticulocyte count Platelet count Serum Urea nitrogen Creatinine Bilirubin, total Direct Indirect Lactate dehydrogenase 5.9 g/dL (N=11-15) 31% (N=28% -45%) 3.1 million/mm³ (N=3.9-5.31) 18,000/mm³ (N=6000-17,500) 4.5% (N=0.5% -1.5%) 52,000/mm³ (N=150,000-400,000) Direct antiglobulin (Coombs) test result is negative. A photomicrograph of a peripheral blood smear is shown. Acetaminophen, amlodipine, and fluid and nutritional support are administered. In addition to thrombi-containing platelet aggregates, which of the following would cause occlusion of small renal vessels in this patient? 210 mg/dL (N=5-18) 1.1 mg/dL (N=0.3-0.7) 2.5 mg/dL (N=0.1-1) 0.2 mg/dL (N=0.0-0.4) 2.3 mg/dL (N=0.1-0.6) 550 U/L (N=120-500)