A 2yr old child is brought to the ED for altered mental status, vomiting, and leathargy. The parents states that this has been occurring since they moved into their grandmother’s home 2 months ago. Vitals signs are within normal limits and CBC reveals a hemoglobin – 10.1 mg/dL, mean corpuscular volume (MCV) – 71 fL/cell, and mean cell hemoglobin concentration (MCHC) – 29.1 g/dL. Peripheral smear and abdominal xray are below.
- What is the most likely diagnosis?
- What is the next diagnostic step?
- What is the first step in the management of this patient?