Q. A 32-year-old woman has been admitted to the hospital for severe anemia following severe menorrhagia. The menorrhagia began seven months ago and did not respond to hormone therapy. Her last blood test showed severe anemia, leukopenia, and thrombocytopenia; therefore, her physician admitted her for a work-up. She is married and has two children (a 10-year-old son and an 8-year-old daughter), both delivered with normal vaginal deliveries without complications, and both are healthy. She has two younger sisters, who are healthy, too. Her menstrual periods were regular and of normal volume until seven months ago, when the bleeding became severe but still regular and for seven days. The anemia appeared after the bleeding started and aggravated gradually. She had recurrent urinary tract infections during the past year. Her vital signs are normal. The blood lab tests show hematocrit 21%, hemoglobin eight g/dL, absolute neutrophil count 480/microL, platelet count 21,000/microL, and reticulocyte count 41,000/microL. The bone marrow biopsy is profoundly hypocellular (22% cellularity), mostly composed of fat cells, with no malignant infiltration or fibrosis. What is the best plan for her initial treatment?

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