<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 27-year-old man comes to the physician because of severe fatigue that started 1 week ago. Ten days ago, he finished a course of oral cephalexin for cellulitis. He does not take any medications. He appears tired. His temperature is 37.5C 99.5F, pulse is 95min, and blood pressure is 12075 mm Hg. Examination shows scleral icterus and pallor of the skin and oral mucosa. The spleen tip is palpated 1 cm below the left costal margin. The remainder of the examination shows no abnormalities. Laboratory studies show:Hemoglobin 10.5 gdLHematocrit 32Reticulocyte count 5SerumLactate dehydrogenase 750 IULHaptoglobin undetectableDirect antiglobulin test positive for IgGA peripheral blood smear shows spherocytes. Which of the following is the most appropriate next step in treatment?? A: Splenectomy, B: Oral prednisone, C: Plasmapheresis, D: Intravenous immune globulin, E: Red blood cell transfusionn,  <response>: This is a question about hemolytic anemia. The patient has fatigue, jaundice, pallor, splenomegaly, anemia, elevated reticulocyte count, elevated LDH, undetectable haptoglobin, positive direct antiglobulin test, and spherocytes on peripheral smear. This presentation is most consistent with autoimmune hemolytic anemia. The question asks about the most appropriate next step in treatment. Choice A of splenectomy may be considered in refractory cases but is not the immediate next step. Choice B of oral prednisone is a reasonable initial treatment to suppress the autoantibody production. Choice C of plasmapheresis can be used to remove autoantibodies but is not typically first-line. Choice D of IVIG can be used to provide antibodies to block autoantibody binding but is also not considered first-line. Choice E of red blood cell transfusion may help temporarily increase hemoglobin but does not treat the underlying cause. Therefore, choice B of oral prednisone is the most appropriate next step in treatment as it targets the autoimmune pathogenesis of this hemolytic anemia.B: Oral prednisone 