Answer:
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Based on the information provided, the most likely diagnosis for the 60-year-old woman is d. Primary thrombocythemia.
Primary thrombocythemia, also known as essential thrombocythemia, is a disorder characterized by an overproduction of platelets in the bone marrow. This condition leads to an abnormally high platelet count in the blood.
In this case, the woman's symptoms of weakness, headaches, dizziness, and tingling in her hands and feet can be attributed to the increased blood viscosity caused by the excess platelets. The presence of multiple areas of bruising on the back of her forearms and shins suggests that the platelets are not functioning properly and may be forming aggregates. The large platelets, platelet aggregates, and megakaryocyte fragments seen on the peripheral smear further support the diagnosis of primary thrombocythemia.
It is important to note that the Philadelphia chromosome studies are negative, ruling out chronic myelogenous leukemia as a possible diagnosis. Additionally, the absence of abnormal red or white blood cells and the normal differential count indicate that the woman does not have myelofibrosis, polycythemia vera, or secondary thrombocythemia.
Primary thrombocythemia can be a chronic condition that requires long-term management to prevent complications such as blood clots or bleeding. Treatment options may include medication to reduce platelet production or aspirin to prevent clotting. Close monitoring and regular follow-up with a physician are important for the woman's overall health and well-being.