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104.

A woman came to the GP with her one-year-old son because of a trivial viral infection of the upper respiratory tract. The doctor noticed paleness of the child. The boy had been fed non-modified cow milk since 6 months of age. He is unwilling to eat anything else than porridge with cow milk. The complete blood count shows: RBC 4 x 10 /µL, Hgb 9.0 g/dL, MCV 60 fL, RDW 18%, PLT 480 x 10 /µL, WBC 9 x 10 /µL. The child had never taken any medications. Indicate the correct management:

A. the boy should be immediately referred to a hospital because of anemia and infection.
B. iron-deficiency anemia should be diagnosed and an oral iron preparation should be prescribed as well as diet modification should be advised.
C. anemia related to the acute infection should be diagnosed; the infection should be cured and the full blood count should be repeated in 2 weeks.
D. the child is well adapted to the anemia and no treatment is needed, only diet modification.
E. megaloblastic anemia should be diagnosed, as a consequence of malnutrition; and oral preparations of folic acid and vitamin B should be prescribed.

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