A 51-year-old man comes to the office due to frequent itching, especially after bathing. He otherwise feels well
except for occasional headaches and dizziness. He has no fever or weight loss. The patient has not visited a
doctor in 10 years and does not take medications. He does not use tobacco, alcohol, or illicit drugs. The patient’s
sister has bipolar disorder, and both parents died in a car accident many years ago. Temperature is 36. 7 C (98 F),
blood pressure is 140/80 mm Hg, pulse is 76/min, and respirations are 14/min. BMI is 30 kg/m2• His face has a
ruddy cyanotic appearance. Oropharynx is clear. There is no ymphadenopathy in his cervical, supraclavicular, or
axillary chains. Jugular venous pressure is normal. Cardiopulmonary examination shows no abnormal ties.
Abdomen is soft and nontender; the spleen is palpable 4 cm below the left lower ribs. Laboratory results are as
follows:
Hemoglobin 21.5 g/dl
Hematocrit 64%
Platelets 521,000/mm3
Leukocytes 14,800/mm3
Which of the following is most likely to be seen on further workup?
- Q A. Elevated erythrocyte sedimentation rate
- 0 B. Elevated serum iron levels
- 0 C. Low resting arterial oxygen saturation
- 0 D. Low serum erythropoietin level
- 0 E. Positive BCR-ABL fusion protein
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