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
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Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: mksap Tags: Conditions Hematology Source Type: blogs