A 61-year-old woman saw her primary care physician because of fatigue and dyspnea on exertion for the past 3 months. Past medical history noted that the patient had been treated 5 years earlier with the DNA alkylating agent cyclophosphamide, non-Hodgkin lymphoma. A CBC revealed the following:
WBC: 3.6 × 10⁹/L
RBC: 2.8 × 10¹²/L
Hb: 9.1 g/dL
MCV: 104 fL
Reticulocyte count: 2.0%
Normal vitamin B₁₂ and folic acid levels
PLT: 120 × 10⁹/L
Differential: 6% blasts
A bone marrow biopsy revealed hypercellularity, and dyshematopoiesis of all three myeloid lineages.
Suggest an appropriate follow-up test and a likely diagnosis for this patient.

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The Answer of A 61-year-old woman saw her primary care physician because of fatigue and dyspnea on exertion for the past 3 months. Past medical history noted that the patient had been treated 5 years earlier with the DNA alkylating agent cyclophosphamide, non-Hodgkin lymphoma. A CBC revealed the following: WBC: 3.6 × 10⁹/L RBC: 2.8 × 10¹²/L Hb: 9.1 g/dL MCV: 104 fL Reticulocyte count: 2.0% Normal vitamin B₁₂ and folic acid levels PLT: 120 × 10⁹/L Differential: 6% blasts A bone marrow biopsy revealed hypercellularity, and dyshematopoiesis of all three myeloid lineages. Suggest an appropriate follow-up test and a likely diagnosis for this patient.

A 61-Year-Old Woman Saw Her Primary Care Physician Because of Fatigue