A 3-year-old Caucasian girl is brought to the community clinic of a rural town because of cough and fever. She looks extremely pale, and a hemoglobin level by finger stick is 1.12 mmol/L (1.8 g/dL). There is no history of trauma, pica,hematemesis, hematochezia, melena, jaundice,or tea-colored urine. The only medication she has taken recently is ibuprofen. She is transferred to the pediatric ward of the regional hospital.

On physical examination, her weight is 10.9 kg, temperature is 39.2°C (102.6°F), pulse is 142 beats/min, and blood pressure is 117/62 mm Hg. She is alert and cooperative, but appears ill, is in mild respiratory distress, and is extremely pale, with no pink color in the nail beds. She has no jaundice or lymphadenopathy. She is breathing at 66 breaths/min with mild retractions; inspiratory and expiratory crackles are audible over the left lung base. An S3 gallop rhythm is noted. Her abdomen is...

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