Cml And Other Myeloproliferative Disorders

A 65-year-old man presents to clinic with fatigue, night sweats, and lethargy of 6 months' duration. He denies having recently had any upper respiratory or gastrointestinal symptoms, although he tells you that he has experienced a 10 lb weight loss over that period. On physical examination, the spleen is palpable 4 cm below the costal margin; the rest of his examination was normal. Laboratory testing is remarkable for leukocytosis (35,000/mm3) and an elevated lactic dehydrogenase level (eight times normal).   What is the most likely explanation for this patient's splenomegaly?

A 68-year-old man presents to the emergency department with fever, night sweats, weight loss, and confusion. His examination reveals pallor, splenomegaly, and diffuse lymphadenopathy. His blood pressure is normal, his heart rate is 104 beats/min, and his respiratory rate is 22 breaths/min. He is disoriented. Stat laboratory testing shows a white blood cell count of 100,000/mm3 with a left shift; the platelet count is 50,000/mm3. Electrolytes are normal. A chest x-ray is unrevealing.   What is the most appropriate initial therapy for this patient?

A 75-year-old man presents to clinic as a new patient. He has hypertension and obstructive lung disease but has otherwise been healthy. He takes hydrochlorothiazide and uses a metered-dose inhaler. He continues to smoke one pack of cigarettes a day despite multiple attempts at quitting. His family history is positive for diabetes and heart disease. His physical examination is remarkable for a prolonged expiratory phase with some wheezing diffusely. Oxygen saturation on room air is found to be 92% at rest but drops to 87% with exertion. The results of laboratory testing, which was done 2 days ago, are normal with the exception of a hematocrit of 58%. You do not have any prior blood counts for comparison.   Which of the following is the most likely cause of this patient's erythrocytosis?

A 68-year-old man presents to the emergency department with headache and shortness of breath. The patient's oxygen saturation on room air is 90%, and he is tachycardic (110 beats/min) and tachypneic (26 breaths/min). On examination, the patient's lungs are clear. The neurologic examination is completely normal. On laboratory testing, the patient's platelet count is 1,600 ( 109/L. A chest CT scan is remarkable for bilateral pulmonary thromboemboli. The patient's coagulation parameters and the rest of his blood counts are within normal limits.   What is the most appropriate therapy for this patient at this time?

A 72-year-old woman comes to your clinic with complaints of fatigue, easy bruising, weight loss, and abdominal distention. Her pulse is slightly fast, and she has notable pallor and splenomegaly. Blood counts reveal anemia and thrombocytosis. You are concerned that she may have myelofibrosis.   What would you expect to see on this patient's peripheral blood smear if she did have myelofibrosis?