question: Q:A 3-year-old boy is brought to the emergency department by his mother for abdominal pain. She states that he has refused to eat and keeps clutching his stomach saying “ow.” She reports that he has not had any vomiting or diarrhea. She says that he has not had a bowel movement in 3 days. The family recently moved from Namibia and has not established care. He has no known medical conditions and takes no medications. The mother says there is a family history of a “blood illness.” On physical examination, there is mild distension with tenderness in the bilateral lower quadrants without organomegaly. An ultrasound of the abdomen reveals 2 gallstones without gallbladder wall thickening or ductal dilation and a negative Murphy sign. An abdominal radiograph shows moderate stool burden in the large bowel and rectum. Labs are obtained, as below:
  
  Hemoglobin: 9 g/dL
  Platelet count: 300,000/mm^3
  Mean corpuscular volume (MCV): 85 µm^3
  Reticulocyte count: 5%
  Lactate dehydrogenase (LDH): 532 U/L
  Leukocyte count: 11/mm^3
  Serum iron: 140 mcg/dL
  Transferrin saturation: 31% (normal range 20-50%)
  Total iron binding capacity (TIBC): 400 mcg/dL (normal range 240 to 450 mcg/dL)
  
  A hemoglobin electrophoresis shows hemoglobin S, increased levels of hemoglobin F, and no hemoglobin A. The results are discussed with the patient’s mother including recommendations for increasing fiber in the patient’s diet and starting hydroxyurea. Which of the following should also be part of management for the patient’s condition?? 
  {'A': 'Folate after age 5', 'B': 'Iron supplementation', 'C': 'Penicillin until age 5', 'D': 'Ursodeoxycholic acid', 'E': 'Vaccination for parvovirus'},