A 68-Year-Old Man Comes to the Office Due to Severe

A 68-year-old man comes to the office due to severe fatigue for the last few months.  He has also had 6.8-kg (15-lb) of unintentional weight loss over the same period.  The patient has no significant medical history and has not seen a physician in many years.  He takes no medications and does not use tobacco, alcohol, or illicit drugs.  Physical examination shows mucosal pallor with no scleral icterus.  The lungs are clear on auscultation, and heart sounds are normal.  Abdominal examination shows mild hepatomegaly and a markedly enlarged spleen.  Stool guaiac testing is negative.  Laboratory results show pancytopenia, and peripheral blood smear is shown below. Bone marrow aspiration is attempted but yields no marrow, and a bone marrow biopsy is subsequently performed.  Which of the following findings is most likely to be observed in this patient's bone marrow?

A) Diffusely fibrotic marrow with clusters of megakaryocytes
B) Hypercellular marrow composed of clusters of plasma cells
C) Increased staining for storage iron in marrow macrophages
D) Marrow replaced by dysplastic cells of all 3 lineages
E) Severely hypocellular marrow replaced by adipose cells

Correct Answer:

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