Question

A 57-year-old man presents for several weeks of fatigue, night sweats, and episodic chills. His exam is remarkable for splenomegaly. A complete blood count shows leukocytosis at 175,000 and mild thrombocytosis. The peripheral blood smear shows a left-shifted myeloid series; blasts are less than 5%. Which of the following additional findings is most consistent with your suspected diagnosis?

a. Auer rods
b. Elevated hematocrit
c. Philadelphia chromosome
d. Rouleaux formation

Answer 1

The additional finding most consistent with the suspected diagnosis, given the patient's symptoms and blood test results, is the presence of the Philadelphia chromosome, which is indicative of chronic myelogenous leukemia (CML).

Step-by-step explanation:

The question presents a clinical scenario involving a 57-year-old man with symptoms of fatigue, night sweats, episodic chills, and splenomegaly. Given the complete blood count (CBC) with leukocytosis and mild thrombocytosis, and noting the myeloid series with <5% blasts, the additional finding most consistent with the suspected diagnosis is likely c. Philadelphia chromosome.

The Philadelphia chromosome is associated with chronic myelogenous leukemia (CML), a myeloproliferative disorder characterized by the overproduction of myeloid cells. This chromosomal abnormality can be found in the aberrant leukocytes of CML patients. Spotting splenomegaly, a high white blood cell count, and the presence of the Philadelphia chromosome provides strong indications for a diagnosis of CML. Although the other options listed—Auer rods, elevated hematocrit, and Rouleaux formation—are relevant in various hematological disorders, they are not as consistent with this patient's presentation, which points towards a diagnosis of CML.