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A 2-year-old boy is brought to the physician for evaluation of pallor and increasing lethargy for 2 days. One week ago, he experienced abdominal pain, vomiting, and bloody diarrhea that have since subsided. The patient's father states that they returned early from a 6-week roadtrip in Mexico because of these symptoms. His parents have been giving him oral rehydration solution. His immunizations are up-to-date. He appears pale. His temperature is 38.4°C (101.1°F), pulse is 130/min, respirations are 35/min, and blood pressure is 95/50 mm Hg. Examination shows scleral icterus. The abdomen is soft and nontender; there is no rebound or guarding. Bowel sounds are hyperactive. The remainder of the examination shows no abnormalities. Laboratory studies show:Hemoglobin 8.5 g/dLMean corpuscular volume 94 μm3Leukocyte count 18,000/mm3Platelet count 45,000/mm3Prothrombin time 12 secPartial thromboplastin time 34 secSerum Urea nitrogen 28 mg/dLCreatinine 1.6 mg/dLBilirubin Total 2.5 mg/dLDirect 0.1 mg/dLLactate dehydrogenase 1658 U/LA blood smear shows schistocytes. Which of the following is the most likely diagnosis?
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