MCQ Hematology 29

A 53-year-old woman comes to see you regarding a possible diagnosis of essential thrombocytosis. She says her gynecologist has noted a platelet count of >550,000/μL on three separate occasions over the past 2 years. Apart from two uneventful childbirths, the woman says she really has no significant medical history. She says she has never been told she was anemic. Lab values reveal a normal hemoglobin, hematocrit, and MCV. The platelet count is 580,000/μL. Your review of the peripheral smear reveals no microcytosis or hypochromia but does show RBC Howell-Jolly bodies. The platelet count on the smear appears elevated, but there are no giant platelets or platelet clumps. What is the next most appropriate step in your diagnostic work-up?

A.Perform bone marrow aspirate and biopsy.
B. Obtain a C-reactive protein and a sedimentation rate, looking for a state of chronic inflammation.
C. Obtain a ferritin level to confirm that there is no iron deficiency.
D. Go back and obtain a more thorough history and repeat the physical exam.
E. Perform chest, abdominal, and pelvic CT scans, searching for an occult malignancy.

Answer

Tags: MCQ, Hematology, Splenectomy

Category: Hematology MCQs