A 52 year old male with history of asplenia after a car accident presents with a fever for 8 days. Tmax is 101.8. Denies any other symptoms. Denies rash. Reports he walks every morning through a path in the woods behind his house. Denies recent travel, animal exposure, sexual history. Blood pressure is 120/80, heart rate is 110, Temperature is 101.0 F, respiratory rate is 18, SpO2 is 100% on room air. Physical exam is otherwise unremarkable. Blood work is significant for evidence of hemolytic anemia and peripheral smear shows maltese cross. What is the next step in management? 

A. Doxycycline

B. Atovaquone and Quinine

C. Vancomycin, Cefepime and Normal saline at 30cc/kg

D. Consult Hematology/Oncology for exchange transfusion. 

Answer = D - Consult Hematology/Oncology for Exchange Transfusion. 

Refer here