Clinical Laboratory Hematology 3rd Edition by Shirlyn McKenzie, Lynne Williams

Exercise 30

A 45-year-old Caucasian female was admitted to the hospital from the emergency room. She had experienced pain in the upper quadrant and bloating for the past several weeks. She had multiple bruises on her legs and arms. She also stated that her gums bled easily when she brushed her teeth. She had been unusually tired and lost about 10 lb in the last 2 months. Results of physical examination showed a massive spleen. The following laboratory results were noted on admission.
Anisocytosis and poikilocytosis were moderate. A bone marrow aspiration was performed. The marrow was 90% cellular with a myeloid-to-erythroid ratio of 10:1. The majority of the cells were neutrophilic precursors. Eosinophils and basophils were increased. Myeloblasts accounted for 10% of the nucleated cells. Megakaryocytes were increased.
What findings suggest that this patient has a defect in the pluripotential stem cell rather than a benign proliferation of hematopoietic cells? (Objective 4)
A) the presence of a leukoerythroblastic blood picture
B) the involvement of several cell lineages in the proliferative process including neutrophilic cells and platelets
C) the shift to the left in the neutrophilic cell line
D) an increase in the RDW