A 45-year-old woman arrives in the emergency department complaining of intense pain in her upper abdomen for the past 4 hours. She had a similar episode in the past, but it went away within an hour. Her history is signifi cant for a recent flu-like infection and a prolonged feeling of fatigue and general exhaustion. Physical examination reveals that her sclerae are icteric, her palate is abnormally pigmented, and her skin has a yellow hue. Ultrasound shows radiopaque gallstones. A Coombs’ test is negative. A peripheral blood smear shows small RBCs, several of which have no central pallor. Which of the following is the most likely cause of this patient’s condition?
(A) A mutation in the gene encoding ankyrin
(B) A mutation in the glucose 6-phosphate dehydrogenase gene
© Circulating antibodies targeted against erythrocytes
(D) Iron defi ciency anemia
(E) RBC hemolysis because of a mechanical heart valve