<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 6-year-old girl is brought to your clinic by her mother with a high grade temperature associated with generalized weakness and lethargy. Her mother reports that she has had similar episodes, each last 3-4 days since she was an infant. These episodes would often lead to hospitalization where she would be found to be anemic and require RBC transfusions. She was born at full term and out of a consanguineous marriage. Her mother also tells you that multiple other relatives had similar symptoms and died at a young age. Her vital signs were, temperature is 37.0C 98.6F, respiratory rate is 15min, pulse is 107min, and blood pressure is 9958 mm Hg. On examination, she was found to have prominent pallor and other physical exam findings were normal. Labs were significant for a low hgb, low hct, normal MCV, high serum iron, high transferrin, high ferritin, and low TIBC. Additionally, a peripheral blood smear is ordered and shows basophilic stippling, anisocytosis, and ringed sideroblasts. Based on these labs, what is the most likely substance deficient in the patient?? A: Niacin, B: Thiamine, C: Folic acid, D: Riboflavin, E: Pyridoxine,  <response>: This is a clinical case scenario about a 6-year-old girl with recurrent episodes of fever, generalized weakness and lethargy since infancy. She requires periodic RBC transfusions due to anemia. There is consanguinity in parents and family history of similar symptoms and early death in relatives. On exam, she has pallor. Labs show low hgb, low hct, normal MCV, high serum iron, high transferrin, high ferritin and low TIBC. Peripheral smear shows basophilic stippling, anisocytosis and ringed sideroblasts. Based on the chronic hemolytic anemia since infancy, consanguinity in parents, family history and peripheral smear findings, this is likely a case of sideroblastic anemia. The high serum iron, transferrin, ferritin and low TIBC indicate iron overload. Ringed sideroblasts on smear confirm sideroblastic anemia. The most common cause of inherited sideroblastic anemia is X-linked sideroblastic anemia due to ALAS2 gene mutations leading to deficiency of pyridoxine vitamin B6.E: Pyridoxine 