<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 52-year-old man comes to to the emergency department with fatigue and shortness of breath that has become progressively worse over the past week. He had an upper respiratory tract infection 2 weeks ago, for which he was given an antibiotic. He has hypertension, type 2 diabetes mellitus, and colonic polyps diagnosed on screening colonoscopy 2 years ago. His mother has systemic lupus erythematosus and his brother has a bicuspid aortic valve. He does not smoke cigarettes or drink alcohol. Current medications include lisinopril and metformin. His temperature is 37.3C 99.1F, pulse is 91min, respirations are 18min, and blood pressure is 14584 mm Hg. His conjunctivae are pale. Cardiac examination shows a late systolic crescendo-decrescendo murmur at the right upper sternal border. Laboratory studies show:Leukocyte Count 9,500mm3Hematocrit 24Platelet Count 178,000mm3LDH 215 ULHaptoglobin 22 mgdL N41165 mgdLSerumNa 140 mEqLK 4.6 mEqLCL- 100 mEqLHCO3- 25 mEqLUrea nitrogen 21 mgdLCreatinine 1.2 mgdLTotal bilirubin 1.9 mgdLA peripheral blood smear is shown. Which of the following is the most likely cause of this patients anemia?? A: Autoimmune destruction of erythrocytes, B: Occult blood loss, C: Erythrocyte membrane fragility, D: Erythrocyte enzyme defect, E: Mechanical destruction of erythrocytes,  <response>: Based on the information provided in the question stem, this patient has a hemolytic anemia. Key findings supporting this include:- Fatigue and shortness of breath - symptoms of anemia- Low hematocrit 24 - indicates anemia- Normal WBC and platelet count - rules out bone marrow failure- Elevated LDH - indicates hemolysis - Low haptoglobin - indicates increased hemoglobin binding from hemolysis- Hyperbilirubinemia - indicates increased bilirubin from hemoglobin breakdown- Peripheral smear not shown - would likely show schistocytes from RBC destructionThe late systolic heart murmur and family history of bicuspid aortic valve raises suspicion for a mechanical cause of hemolysis. Of the choices given, A autoimmune and C RBC membrane defect would not explain the murmur finding. B occult blood loss would cause iron deficiency anemia, not hemolysis. D enzyme defects present earlier in life. E mechanical destruction of RBCs is most consistent with the clinical presentation. The murmur and family history point towards abnormal turbulence from a cardiac valve defect as the likely cause of mechanical hemolysis.E: Mechanical destruction of erythrocytes 