A 24-year-old man comes to the physician for a 1-day history of severe right upper quadrant pain. Temperature is 102 F. He has a hematologic disorder that was recently diagnosed with an osmotic fragility test and eosin-5-maleimide flow cytometry. Hemoglobin is 10 g/dL. He is scheduled to undergo a splenectomy and cholecystectomy. Ultrasound of the abdomen is equivocal. A HIDA scan is performed and shows non-visualization of the gall bladder. An example of a normal HIDA scan from a separate patient is shown below.
Which of the following is the most likely etiology for this patient’s fever?
Clearance of erythrocytes by red pulp
Common bile duct obstruction
Hepatopancreatic ampulla obstruction
Decreased secretion of cholesterol into bile
Increased hepatic production of bilirubin
