Review Question - QID 214641

A 51-year-old man presents to his primary care physician with a 3-month history of fatigue and easy bruising. He says that he no longer has the energy to perform his job as a construction worker and is afraid that he will lose his job. Otherwise, he says that he feels abnormally warm sometimes but has not taken his temperature at home. His past medical history is significant for endocarditis for which he had an artificial valve placed 6 years ago. Physical exam reveals conjunctival pallor, bruising over his legs, and splenomegaly. A heart murmur is heard over the aortic valve but this is unchanged from previous. A peripheral blood smear is obtained, and the results are shown in Figure A. Which of the following is occurring in this patient?