Would love some input on this case. 11 year old FI Redbone presenting for lethargy and decreased appetite. No reported vomiting or diarrhea. Her ultrasound was not that exciting (sorry for no photos). She had an enlarged, homogenous liver w/ normal echogenicity. Her uterus did have some anechoic fluid (mild). Did not have a complete hx to know when her last heat was, but no hx of vaginal discharge. Blood work – normal WBC, HCT 17 w/ evidence of increased reticulocytes and platelets were about 100,000. No blood smear performed that I could see. The albumin was low at 1.9. Normal liver values including T bili. Quick peak at heart w/ ultrasound was unremarkable
I had suggested they start w/ a blood smear, slide agglutination, coags, and thoracic rads. Then FNA of liver. Any other thoughts?