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Answer 2
  1. Autoimmune hemolytic anemia. This case is most consistent with autoimmune hemolytic anemia, a known complication of CLL. The relatively rapid onset of symptoms and anemia, along with the presence of spherocytes on peripheral blood smear, are all consistent with autoimmune hemolysis. A direct Coombs test would establish the diagnosis. Prednisone is generally the initial therapy of choice. The anti-CD20 antibody, rituximab is an effective second-line therapy. Treatment of underlying CLL with chemotherapy is not necessary. Pure erythrocyte aplasia is a rare complication of CLL caused by the generation of autoantibodies against erythrocyte precursors. Unlike autoimmune hemolytic anemia, pure erythrocyte aplasia usually is indolent in onset. Idiopathic thrombocytopenic purpura is a complication of CLL but is unlikely in this case due to the minimal change in platelet count. Splenic sequestration is unlikely given the lack of a palpable spleen. Rapid progression of CLL is unlikely based upon the natural history of the disease, the lack of progressive lymphadenopathy, and the lack of thrombocytopenia.

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