A 46-Year-Old Woman Is Being Evaluated for Tiredness, Low Energy

A 46-year-old woman is being evaluated for tiredness, low energy level, and poor exercise tolerance.  She also complains of joint pains and takes non-steroidal anti-inflammatory agents.  Her past medical history is significant for hypertension and type 2 diabetes mellitus.
Her blood pressure is 130/80 mm Hg, pulse is 96/min, and respirations are 12/min.  Her BMI is 32 kg/m2.  The cardiac, pulmonary, and abdominal examinations are within normal limits.  Her skin shows areas of hypopigmentation consistent with vitiligo in the upper extremities bilaterally.
Her laboratory studies are shown below.

Bone marrow aspiration is performed, and the aspirate is stained with Prussian blue for iron.  It shows dense iron staining in macrophages but no staining of erythrocyte precursors.
Which of the following is the most likely diagnosis?

A) Anemia of chronic disease
B) Aplastic anemia
C) Essential thrombocytosis
D) Iron deficiency
E) Pernicious anemia

Correct Answer:

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