A 32-year-old woman presents at her neighborhood health clinic complaining of weakness and a feeling of abdominal fullness. She reports that 6 months earlier she noticed that she had difficulty in maintaining the high level of energy she has relied on during her aerobic workouts over the past few years. Because she felt that she was in overall good health, but knew that women often need additional iron, she added a multiple vitamin with iron and some meat and leafy greens to her diet. She followed her plan carefully but had no increase in energy. Upon examination, her spleen is noted to be enlarged. Which of the following is most likely to be the cause?

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Typically, CML follows a triphasic course: (1) a chronic phase of variable length, (2) a short accelerated phase, and (3) a terminal blast crisis phase. The onset of the chronic phase is usually slow with nonspecific symptoms. Anemia causes weakness, easy fatigability, and exertional dyspnea. The accelerated phase is characterized by enlargement of the spleen and progressive symptoms. Persons with Hodgkin disease are commonly designated as stage A if they lack constitutional symptoms and stage B if significant weight loss, fevers, pruritus, or night sweats are present. In cases of infectious mononucleosis, most persons seek medical attention for severe pharyngitis, which usually is most severe on days 5 through 7 and persists for a total of 7 to 14 days. CLL is mainly a disorder of older persons; fewer than 10% of those who develop the disease are younger than 50 years of age. Men are affected twice as often as women.

A 32-Year-Old Woman Presents at Her Neighborhood Health Clinic Complaining