Virtual Slide: A 32-year-old white man is referred because of abnormal CBC

This 32 year-old white man was referred because of an abnormal CBC that was part of his pre-employment physical at a local school. His only complaints were weight loss and fatigue. Physical exam reveals a pale, thin and apprehensive young man. He experienced mild LUQ abdominal pain during the exam, and his spleen was enlarged. No adenopathy was observed. WBC  89.1 X 103   RBC    2.85          Percent    Abs   HGB    8.4   NE    89.5     79.8   HCT     23.9   LY      5.6       5.0   MCV     83.8   MO     2.3       2.0   MCH     29.6   EO      2.6      2.3   MCHC   35.3   BA        0         0   RDW     15.8   Many immature cells   PLT      565 X 103 Reference values?     MPV      8.4

Click the red + in the smear above to see the slide using the virtual microscope. Describe what you see and then answer the following questions. Define a myelproliferative disorder (MPD). What's the most likely diagnosis here? How would you confirm it? What is the PH1 chromosome? In what cells do you find it? Click the image to the right for more info. What would the marrow look like. What's with his big spleen? What would a serum vitamin B12 show? The next patient complains of fever.

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