<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:An 8-year-old male presents to his pediatrician for a follow-up appointment for persistent fatigue. His mother reports that the patients teacher called her yesterday to tell her that her son has been sitting out of recess every day for the past week. The patient first developed symptoms of fatigue and weakness several years ago and has returned to the physician with similar episodes once or twice a year. These episodes seem to sometimes be triggered by viral illnesses, but others have no identifiable trigger. The patient has been on daily folate supplementation with some improvement and requires red blood cell transfusions several times a year. He has an allergy to sulfa drugs, and last month he was treated with amoxicillin for an ear infection. His paternal grandfather was recently diagnosed with multiple myeloma, but his parents deny any other family history of hematologic conditions. Her temperature is 99.0F 37.2C, blood pressure is 10376 mmHg, pulse is 95min, and respirations are 14min. On physical exam, the patient is tired-appearing with conjunctival pallor. Laboratory tests performed during this visit reveal the following:Leukocyte count: 9,7000mm3Hemoglobin: 8.4 gdLHematocrit: 27Mean corpuscular volume: 97 μm3Mean corpuscular hemoglobin concentration MCHC: 40 HbcellPlatelet count: 338,000mm3Reticulocyte index RI: 4.2What is the next step in management?? A: Hydroxyurea, B: Glucocorticoids, C: Stem cell transplant, D: Vaccinations followed by splenectomy, E: Vaccinations followed by splenectomy and penicillin for one year,  <response>: This is a clinical case about an 8-year-old boy with persistent fatigue, weakness, and recurrent episodes of anemia requiring transfusions. He has a family history of multiple myeloma in his paternal grandfather. His lab tests show anemia with low hemoglobin, hematocrit, and MCHC, but an elevated reticulocyte index, suggesting increased production of red blood cells. The persistent anemia and reticulocytosis point towards a diagnosis of hereditary spherocytosis, an inherited red blood cell membrane disorder that leads to premature destruction of red blood cells by the spleen. The treatment for hereditary spherocytosis is splenectomy, which reduces the destruction of red blood cells and improves anemia. However, before splenectomy, the patient needs to be vaccinated against encapsulated organisms like pneumococcus, meningococcus, and Haemophilus influenzae, as the spleen helps fight these infections. After splenectomy, penicillin prophylaxis is recommended to prevent infections.So the correct next step in management is vaccinations followed by splenectomy and penicillin prophylaxis.E: Vaccinations followed by splenectomy and penicillin for one year 