A case from a lecture that highlights how slow it is. This patient has had it for over seven years. Skip past all this if you're not into all the medical mumbo jumbo.
What is the most likely diagnosis?A 54 yr-old woman presents to your office with fever and persistent bleeding from a dental extraction done 3 weeks ago. The patient has felt well for the past month with no fevers or weight loss, but she has had some fatigue that she attributes to long hours at work. Seven years ago she was noted to be pancytopenic and was diagnosed with aplastic anemia. She was treated with antithymocyte globulin, cyclosporine, and prednisone and had a complete hematologic recovery.
Physical examination shows a pale, middle-aged woman. There is no lympadenopathy or hepatosplenomegaly.
Hemoglobin 8.2 g/dl
Mean corpuscular volume 117fL
Leukocyte count 3100μL
–Segmented neutrophils 21%
–Band forms 10%
Platelet count 36,000/μL
Peripheral blood morphology shows hypogranular and hyposegmented neutrophils. The erythrocyte morphology shows both anisocytosis and poikilocytosis with some teardrop cells.
a) recurrent aplastic anemia
b) chronic lymphocytic leukemia
d) B12 deficiency
e) Miliary tuberculosis