A 68-Year-Old Man Is Evaluated for Exertional Fatigue

A 68-year-old man is evaluated for exertional fatigue.  He used to play tennis actively but now is having a hard time finishing a set.  His only other medical problem is hypertension.  He does not use tobacco, alcohol, or illicit drugs.  Temperature is 37 C (98.6 F) , blood pressure is 126/86 mm Hg, and pulse is 82/min.  Mild mucosal pallor is present.  There is no lymphadenopathy.  Cardiopulmonary examination is normal.  There is no splenomegaly or lower extremity edema.  Laboratory results are as follows: Peripheral blood smear is shown in the exhibit.  Which of the following is most likely to be found on the patient's bone marrow biopsy?

A) Clonal plasma cell proliferation
B) Hypocellular and fibrotic bone marrow
C) Hypoplastic fat-filled marrow
D) Megaloblastic erythroid hyperplasia
E) Ring sideroblasts

Correct Answer:

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