<prompt> A 72-year-old man who has recently had an aoic valve replacement now presents with pallor and fatigue. The red blood cell count is decreased, and schistocytes are repoed on examination of a peripheral blood smear. In addition, his indirect unconjugated bilirubin is significantly elevated. The cause of the anemia is likelycold agglutinin disease.dietary deficiency.hereditary spherocytosis.mechanical disruption of red cells.  <response>: - Turbulent blood flow over mechanical hea valves can cause shearing of RBC, resulting in fragmented cells termed schistocytes. -The hemolysis can result in anemia and hyperbilirubinemia. OTHER OPTIONS: - cold agglutinin disease - Triggered by cool temperatures, hemolysis is dt antibodies against RBC - Hereditary spherocytosis causes hemolytic anemia dt intrinsic defect in red blood cells - Dietary deficiencies dont cause fragmented RBC. 