Match each clinical and laboratory presentation with the most likely underlying hematologic diagnosis.
- A 45-year-old woman with confusion, fever, petechiae, and acute kidney injury. Labs show hemoglobin 8.2 g/dL, platelets 18,000/mm³, normal PT/PTT, and numerous schistocytes.Thrombotic thrombocytopenic purpura (TTP)
- A 62-year-old man with aquagenic pruritus and erythromelalgia. Labs show hematocrit 58%, WBC 14,000/mm³, platelets 450,000/mm³, and decreased serum erythropoietin.Polycythemia vera
- A 35-year-old woman with epistaxis and ecchymoses. Labs show isolated thrombocytopenia of 22,000/mm³ with normal hemoglobin, WBC count, and coagulation studies. Smear shows megathrombocytes.Immune thrombocytopenia (ITP)
- A 55-year-old man with fatigue, night sweats, and massive splenomegaly. Labs show WBC 85,000/mm³ with a left shift including basophilia and a low leukocyte alkaline phosphatase score.Chronic myeloid leukemia (CML)
Answer
Properly align each clinical vignette with its corresponding hematologic malignancy or disorder based on unique laboratory and symptomatic clues.
Each diagnosis uniquely matches a constellation of symptoms and lab findings. TTP is defined by MAHA and thrombocytopenia with normal coagulation parameters. Polycythemia vera presents with primary erythrocytosis (low EPO) and aquagenic pruritus. ITP presents with isolated thrombocytopenia in the absence of other systemic illnesses. CML is a myeloproliferative disorder characterized by massive splenomegaly, prominent basophilia, and a low LAP score.
Step-by-Step Solution
Key Concept
Accurate diagnosis of hematologic disorders relies on recognizing pathognomonic clinical features paired with specific laboratory abnormalities, such as smear findings (schistocytes, megathrombocytes) or functional assays (LAP score, EPO levels).