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A 28-year-old man, a second-year resident in internal medicine, presents in the emergency department with nausea, vomiting, and diarrhea along with crampy abdominal pain that started 2 days ago during a flight

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It can show larger than normal red blood cells (macro-ovalocytes), neutrophils (a type of white blood cell) with more segments than normal (hypersegmented neutrophils) and variable red blood cell size and shape (anisopoikilocytosis)

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