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A 65-year-old male presen ts for further evaluation secondary to progressive dyspnea on exertion, orthopnea, and left upper quadran t abdomi nal pai n. Physical examination reveals massive splenomegaly and bilateral lower extremi ty edema. Laboratory workup shows hemoglobin of 9.3 g/dl, leukocyte count of 1 8, 500/JLL, and platelets of LJ58,000/JLL. Peripheral blood smear is shown below.
What is the most likely diagnosis?
- Hemolytic anemia
- Beta thalassemia major
- Myelofibrosis
- Myelodysplastic syndrome
- Iron-deficiency anemia
Medicine
C. Peripheral blood smear shows nucleated red blood cells (RBC), dacrocytes (teardrop RBCs), and giant platelets. This picture in concert with splenomegaly is most consistent with myelofibrosis. Myelodysplastic syndrome can also present with nucleated and teardrop RBCs in the peripheral blood; however, the elevated platelet and leukocyte count in addition to splenomegaly make this less likely. Bone marrow biopsy and reticulin staining of the bone marrow sample demonstrated extensive fibrosis.
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