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A 42-year female patient presents to her primary care physician complaining of low-grade fever, fatigue, and upper respiratory symptoms for the past week. She’s concerned that she may have the flu or a sinus infection. She states that she is in treatment for metastatic melanoma and doesn’t want her treatment to be delayed because of her symptoms. She reports that she has recently begun a combination immune checkpoint inhibitors.

She is pale with some jaundice. Her BP is 84/48 with an increased heart rate of 120. Her lungs are clear upon auscultation. Her spleen is enlarged upon palpitation. She does not show ecchymoses or petechiae.

Her laboratory results were disturbing.

Hemoglobin = 3.1 mg/dL
Platelets = 77 × 10^3/uL
Bilirubin = 2.8 mg/dL (1.6 mg/dL unconjugated)
She denies any bleeding.

How should this patient be stabilized?

What additional testing is needed to determine the cause of her symptoms?

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