Test your medicine knowledge: 48-year-old woman with fatigue

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 48-year-old woman is evaluated for fatigue and intermittent abdominal discomfort of 2 months’ duration and occasional dark urine. Medical and family histories are unremarkable. Her only medication is an oral contraceptive pill. On physical examination, temperature is 37.2 °C (99.0 °F), blood pressure is 125/74 mm Hg, pulse rate is 68/min, and respiration rate is 13/min. Pallor is observed, and abdominal tenderness is present on palpation. No icterus, bruising, or splenomegaly is noted. Laboratory studies: Hemoglobin 7.2 g/dL (72 g/L) Leukocyte count 3000/µL (3 × 109/L) with a normal differential Platelet count 125,000/µL (125 × 109/L) Reticulocyte count 8% of erythrocytes Bilirubin, total Normal Direct antiglobulin (Coombs) test Negative A bone marrow biopsy shows 20% cellularity. Flow cytometry reveals erythrocytes lacking CD55 and CD59. Abdominal ultrasonography shows portal vein thrombosis. Which of the following is the most likely diagnosis? A: Aplastic anemia B: Myelodysplastic syndrome C: Myeloproliferative neoplasm D: Paroxysmal nocturnal hemoglobinuria Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Conditions Hematology Source Type: blogs