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Review Question - QID 214277

Pure Red Cell Aplasia Introduction QID: 214277 (M1.OMB.20.1)
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QID 214277 (Type "214277" in App Search)
A 39-year-old woman presents to her primary care physician with a 3-week history of increasing fatigue. She says that she feels less energetic than before and cannot complete the morning walks she previously liked to take. She says that she switched to a vegan diet about 3 months ago and has been experiencing heavy menstrual flow since she had a copper intrauterine device placed about 6 months ago. Otherwise, she complains of mild joint pain throughout. Physical exam reveals conjunctival pallor but no murmurs or respiratory findings. A selection of laboratory tests are performed with the following results:

Hemoglobin: 8.2 g/dL
Mean corpuscular volume: 87 fL
Lactate dehydrogenase: 52 U/L
Ferritin: 77 ng/mL
Erythropoietin: 51 IU/L (normal 5-35 IU/L)

Which of the following is most likely responsible for this patient's symptoms?
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