Hematology

A 57-year-old male with low back pain and anemia was diagnosed with multiple myeloma. Hospital tests revealed: Hb 83g/L, urinary protein (+++), BUN 20mmol/L, Cr 200μmol/L, IgG 80g/L, IgA 3.0g/L, IgM 0.8g/L. Bone marrow smear showed plasmablasts + immature plasma cells at 16%, mature plasma cells at 20%. Multiple skeletal X-rays were normal. What is the clinical stage and group?

An acute leukemia patient presents with headache, nausea, vomiting, increased cerebrospinal fluid (CSF) pressure, elevated protein, and predominantly leukemic cells in CSF. The first-choice drug for intrathecal injection is:

An 18-year-old male presents with fever for 2 months. Physical examination reveals lymphadenopathy in the neck and axilla, liver palpable 2 cm below the costal margin, spleen palpable 3 cm below the costal margin, and petechiae. Lab results: hemoglobin 76 g/L, WBC count 7.2×10⁹/L, platelets 65×10⁹/L. Symptoms resolved after treatment with the VDP regimen (vincristine, daunorubicin, prednisone). The most likely diagnosis is:

A 52-year-old male presents with low-grade fever for 6 months, generalized lymphadenopathy, liver palpable 5 cm below the costal margin, hemoglobin 110 g/L, WBC count 200×10⁹/L, bone marrow myeloblasts 2%, and Ph chromosome positive. The diagnosis is:

A 15-year-old girl presents with fever, mucocutaneous bleeding, headache, nausea, and vomiting for 2 weeks. Physical examination reveals generalized lymphadenopathy, hepatomegaly, and splenomegaly. Lab results: PLT 70g/L, WBC 16×10⁹/L, platelets 45×10⁹/L. Bone marrow shows increased blasts, negative peroxidase staining, and granular positivity on glycogen staining. CSF Pandy's reaction is positive. The most likely diagnosis is:

A 42-year-old woman presents with high fever and mucocutaneous bleeding for 1 week. Hemoglobin (Hb) 75g/L, white blood cell (WBC) count 14×10⁹/L, platelets (PLT) 65×10⁹/L. Bone marrow shows 90% myeloblasts + promyelocytes. The most appropriate treatment is:

A 45-year-old woman presents with fever and mucocutaneous bleeding for 1 week. Examination shows anemic appearance, sternal tenderness, hemoglobin 70g/L, WBC count 14×10⁹/L, and platelets 12×10⁹/L. The most essential investigation is:

A 23-year-old male presents with gingival bleeding and high fever for 2 weeks. Physical examination reveals sternal tenderness, no hepatosplenomegaly, and scattered petechiae on the lower limbs. Lab results: WBC 96×10⁹/L, Hb 110g/L, PLT 24×10⁹/L. The most likely diagnosis is:

A 20-year-old male presents with fever for 2 weeks, accompanied by skin bleeding, tenderness at the lower sternum (+), and spleen palpable 1.5 cm below the costal margin. Lab results: hemoglobin 80 g/L, white blood cell (WBC) count 2.0×10⁹/L, platelet count (PLT) 35×10⁹/L. The most likely diagnosis is:

A patient with acute leukemia develops severe bleeding symptoms after chemotherapy, accompanied by blurred vision. Examination reveals patchy hemorrhages in both fundi, with a platelet count (PLT) of 10×10⁹/L. The most effective treatment at this time is:

A 16-year-old male presents with irregular fever for half a month, bone pain, and gingival bleeding. Physical examination shows sternal tenderness (+) and spleen 2 cm below the costal margin. Lab results: hemoglobin 70g/L, WBC count 18×10⁹/L with 20% blasts, platelets 40×10⁹/L. The most likely diagnosis is:

A 35-year-old male shoemaker presents with fever, cough, and gingival bleeding for 10 days, along with one episode of syncope. Physical exam: anemic appearance, scattered petechiae and ecchymoses on skin, 3-4 peanut-sized cervical lymph nodes (firm, mobile, no tenderness), marked tenderness at lower sternum, fine rales at lung bases, liver palpable 1.5 cm below costal margin, spleen palpable 3 cm below costal margin (firm consistency). The most diagnostic auxiliary test is:

A 22-year-old male presents with dizziness, fatigue, epistaxis, and gingival bleeding for 1 week. Laboratory tests: Hb 85g/L, WBC 42×10⁹/L, PLT 23×10⁹/L. Peripheral blood smear shows immature cells. Bone marrow smear reveals hypercellularity with 50% blasts, 21% promyelocytes, strongly positive POX, negative NAP, and NSE partially positive (not inhibited by NaF). The diagnosis is acute myeloid leukemia (AML). What is the FAB classification?

A 30-year-old male farmer presented with fatigue and weight loss 2 years ago, with splenomegaly noted at a local clinic. He took 10 doses of Chinese herbal medicine without further evaluation. Over the past month, he developed fever, dizziness, bone and joint pain, and petechiae. Examination revealed an anemic appearance, cervical lymphadenopathy, sternal tenderness, liver 2 cm below the costal margin, and spleen 2 cm below the umbilicus. Lab tests showed decreased red blood cells (RBC) and platelets (PLT), elevated white blood cells (WBC), and bone marrow smear with blasts and immature lymphocytes accounting for 82%. The most likely diagnosis is:

A 65-year-old male farmer presents with dizziness, fatigue, bone pain, and irregular fever for 2 months. Physical examination: anemic appearance, scattered petechiae on the skin, no sternal tenderness, spleen 2 cm below the costal margin. Laboratory tests: Hb 60 g/L, WBC 30×10⁹/L, PLT 25.6×10⁹/L, with 42% blasts. The family requests hospitalization. Which of the following management approaches is inappropriate?

A 40-year-old male with a 5-year history of chronic active hepatitis and ascites for 1 year presents with gingival bleeding, epistaxis, and scattered ecchymoses over the past 2 months. Physical exam: chronic liver disease facies, icteric sclera, spleen palpable 5 cm below the costal margin, shifting dullness (+). The most likely cause of his significant bleeding tendency is:

A 32-year-old male with chronic renal failure undergoing hemodialysis with systemic heparin anticoagulation develops oozing blood from the wound post-dialysis. Laboratory tests show coagulation time of 30 minutes. Which measure should be taken?

A 16-year-old male presents with pain and swelling in the right thigh after a bicycle fall. Examination reveals a 10cm × 8cm hematoma in the upper right thigh with marked tenderness. Laboratory tests: normal bleeding time, clotting time 14 minutes, APTT prolonged by 20 sec compared to control, not corrected by normal BaSO₄-adsorbed plasma but corrected by normal serum. What is the first-line treatment?

A 50-year-old male presents with anemia and gingival bleeding for 6 months. Physical examination shows anemic appearance with hepatosplenomegaly. Hemoglobin (Hb) is 50g/L, white blood cell (WBC) count is 3.4×10⁹/L, and platelets (PLT) are 6×10⁹/L. Blood smear shows nucleated red blood cells. Mean corpuscular volume (MCV) and mean corpuscular hemoglobin concentration (MCHC) are normal. The most likely diagnosis is:

A 50-year-old male presents with fatigue for 1 year and gingival bleeding for 1 week. Physical examination: no lymphadenopathy, spleen palpable 1 cm below the costal margin. Lab results: hemoglobin (Hb) 75 g/L, white blood cell (WBC) count 3×10⁹/L, platelets (PLT) 60×10⁹/L. Blood smear shows giant platelets and macrocytic red blood cells. Bone marrow reveals 7% myeloblasts, small megakaryocytes, and erythroid precursors with prominent megaloblastic changes. No response to androgen or vitamin B₁₂ therapy. The diagnosis is:

A 50-year-old male presents with pallor and fatigue for 1 year, accompanied by left upper abdominal discomfort. Physical examination reveals liver 2 cm below the costal margin and spleen palpable at the umbilicus. Lab results: Hb 65 g/L, platelets 160×10⁹/L, peripheral blood shows few immature granulocytes and nucleated red blood cells (RBC). Multiple bone marrow aspirations yield 'dry tap'. The most likely diagnosis is:

In a patient with myelodysplastic syndrome, the presence of Auer rods in bone marrow blast cells is seen in:

A 60-year-old male diagnosed with multiple myeloma has laboratory tests showing Hb 72g/L, urinary protein (++), blood urea nitrogen (BUN) 16mmol/L, creatinine (Cr) 210μmol/L, IgG 36g/L, IgA 0.9g/L, IgM 0.4g/L, bone marrow plasma cells 46%, and normal findings on multiple bone X-rays. What is the clinical stage and group?

A 68-year-old male presents with progressive anemia for 1 year, severe flank pain for 3 months, and recent rib fracture due to sneezing. Liver and spleen are non-palpable. Hemoglobin (Hb) 90g/L, white blood cell (WBC) count 3.4×10⁹/L, platelets (PLT) 70×10⁹/L. Erythrocyte sedimentation rate (ESR) 120 mm/h, urinary protein (+++), serum protein electrophoresis (SPEP) shows monoclonal protein (M protein), elevated immunoglobulin G (IgG), and 60% abnormal plasma cells in bone marrow. Lumbar spine X-ray reveals osteoporosis and round punched-out lytic lesions. The most likely diagnosis is:

A 76-year-old male presents with intermittent fever and low back pain for 5 months. Laboratory tests show Hb 76g/L, normal WBC and PLT, urinary protein (+++), Bence Jones protein (+), no M-spike on serum protein electrophoresis (SPEP), IgG 4g/L, IgA 0.9g/L, IgM 0.6g/L, undetectable IgD and IgE, bone marrow plasma cells 56%, and L1-L3 vertebral compression fractures on X-ray. A diagnosis of multiple myeloma is made. What is its type?

A 38-year-old male with a 2-year history of confirmed cirrhosis presents with anemia and gingival bleeding. Physical exam shows chronic liver disease facies, spider angiomas on the chest, and splenomegaly (5 cm below the costal margin). Laboratory tests: Hb 80g/L, WBC 4×10⁹/L, PLT 53×10⁹/L, IgG 22g/L, IgA 15g/L, IgM 1.0g/L. Bone marrow smear shows 10% mature plasma cells. The most appropriate diagnosis is:

A 62-year-old male presents with back pain for 6 months. X-rays of the thoracic/lumbar spine and ribs show wedge-shaped compression of T10, L1, and L3 vertebrae, along with multiple osteolytic rib lesions. Lab results: Hb 82g/L (anemia), ESR 96mm/h, urinary protein (+++), negative Bence-Jones protein, albumin 31g/L, globulin 62g/L. The most likely diagnosis is:

A 62-year-old male presents with dizziness and fatigue for 6 months, and irregular fever for 3 months. Physical exam: anemic appearance, multiple bean-sized lymph nodes in the neck and supraclavicular region, liver 2 cm below the costal margin, spleen 4 cm below the costal margin. Laboratory tests: Hb 65g/L, red blood cells (RBC) showing rouleaux formation, positive Bence Jones protein in urine, erythrocyte sedimentation rate (ESR) 152mm/h, immunoglobulin G (IgG) 12g/L, immunoglobulin A (IgA) 3g/L, immunoglobulin M (IgM) 11g/L, bone marrow smear shows lymphoplasmacytic cells accounting for 30%. The most likely diagnosis is:

A 68-year-old woman presents with fatigue and pallor for 3 months. Lab results: WBC 3.5×10⁹/L, RBC 1.5×10¹²/L, Hb 70g/L, PLT 87×10⁹/L. History reveals poor appetite, reduced food intake, and abdominal distension for months. Physical exam: pale-yellow complexion, no enlargement of superficial lymph nodes, liver, or spleen. Bone marrow aspiration shows active bone marrow proliferation with erythroid hyperplasia and megaloblastic changes, hypersegmented neutrophils, and large platelets. Gastroscopy reveals chronic superficial gastritis. The most likely diagnosis is:

A 50-year-old male underwent total gastrectomy for gastric cancer 5 years ago. Over the past year, he has progressively experienced dizziness, fatigue, palpitations, and shortness of breath on exertion. Laboratory tests show: RBC count 1.5×10¹²/L, hemoglobin 55g/L, WBC count 3.2×10⁹/L, platelets 65×10⁹/L, reticulocytes 0.001 (0.1%). MCV 129fl (129μm³), MCH 36pg, MCHC 34%. The most likely diagnosis is:

A 36-year-old male presents with dizziness and fatigue for 2 months. Laboratory tests: RBC count 1.4×10¹²/L, hemoglobin 60 g/L, serum folate 6.8 μmol/L, vitamin B₁₂ 44 pmol/L. Diagnosed with megaloblastic anemia. After 1 month of folate and vitamin B₁₂ therapy, hemoglobin rose to 90 g/L but plateaued for 2 weeks. The correct management is:

A 28-year-old male presents with dizziness, palpitations, fatigue for 1 year, accompanied by limb numbness and unsteady gait. Past medical history includes Crohn's disease. Physical examination reveals severe anemic appearance, heart rate 120 bpm, Romberg's sign (+), and heel-knee-shin test (+). Megaloblastic anemia is suspected. Which laboratory test is most definitive for diagnosis?

A 35-year-old woman presents with dizziness, fatigue, palpitations, and unsteady gait for 6 months. Laboratory tests show: RBC 1.8×10¹²/L, Hb 70g/L, MCV 130fl (130μm³). Bone marrow aspiration confirms megaloblastic anemia. Which of the following management options is inappropriate?

A 32-year-old male presents with irregular fever for 2 months, accompanied by poor appetite, weight loss, and pruritus. Physical examination reveals temperature 39°C, multiple bean-sized hard, mobile, non-tender lymph nodes in the neck and supraclavicular region, liver palpable 1 cm below the costal margin, and spleen palpable 3 cm below the costal margin. Laboratory tests show WBC 25×10⁹/L (N 85%, L 10%, E 5%). Multiple antibiotic treatments were ineffective, but indomethacin provided temporary fever relief. Which test is most appropriate for definitive diagnosis?

A 40-year-old male presents with left cervical lymphadenopathy for 1 month. Lymph node biopsy reveals fibrosis with focal necrosis, infiltration by neutrophils, eosinophils, plasma cells, lymphocytes, and histiocytes, along with abundant Reed-Sternberg cells. The histological subtype is:

A 52-year-old male presents with chills and fever for 14 days. Examination: temperature 39.5°C, blood pressure (BP) 75/50 mmHg, ecchymoses on the right upper limb, coarse breath sounds in both lungs, respiratory rate 30/min, liver not palpable below the costal margin, spleen just palpable below the costal margin; hemoglobin (Hb) 112 g/L, white blood cell count (WBC) 18×10⁹/L, prothrombin time (PT) 17 sec (control 12 sec), fibrinogen 1390 mg/L. The most likely diagnosis is:

A patient with sepsis develops delirium, decreased blood pressure (BP), ecchymoses, and persistent oozing blood at injection sites. Lab results: platelets (PLT) 42×10⁹/L, fibrinogen 8g/L, prothrombin time (PT) 25 sec, INR 2.0, APTT 60 sec. The most likely cause of bleeding is:

A 26-year-old female presents with facial pallor, fatigue, and purpura for one year. Physical examination shows mild icterus of the sclera. Lab results: Hb 60g/L, RBC 1.8×10⁹/L, WBC 4.6×10⁹/L, PLT 36×10⁹/L. Coombs test (+), Rous test (-). Bone marrow shows marked hyperplasia with normal myeloid series distribution. Erythroid series accounts for 0.32, with prominent dysmorphic mature RBCs (spherocytes and teardrop cells). Megakaryocytes: 96 (92% granular, 8% naked nuclei; no platelet-producing forms). The most likely diagnosis is:

A 30-year-old woman presents with fatigue and palpitations on exertion for over a year. Physical examination reveals conjunctival and lip pallor, heart rate of 110 bpm, and a grade II systolic murmur at the apex. Laboratory tests show hemoglobin (Hb) 60g/L, mean corpuscular hemoglobin concentration (MCHC) 0.25 g/dl, mean corpuscular volume (MCV) 70μm³, serum iron 6.2μmol/L, serum transferrin saturation 10%, and total iron-binding capacity (TIBC) 3690μmol/L. The most likely diagnosis is:

A 30-year-old farmer presents with dizziness and fatigue. Stool examination shows +++ hookworm ova, and hemoglobin is 60 g/L. The treatment should be:

A 22-year-old woman presents with dizziness and fatigue for 6 months. She reports menorrhagia lasting 7-8 days with blood clots for the past 2 years. Laboratory tests show RBC 3.0×10¹²/L, hemoglobin 65g/L, serum ferritin 10μg/L, serum folate 16 ng/ml, vitamin B₁₂ 600 pg/ml, and reticulocytes 0.015 (1.5%). The most likely diagnosis is:

A 35-year-old female farmer with no significant past medical history presents with pallor, dizziness, and fatigue for 1 year. Laboratory tests: RBC count 1.9×10¹²/L, hemoglobin 45g/L, WBC count 5.4×10⁹/L (neutrophils 70%, lymphocytes 16%, eosinophils 14%). Peripheral smear shows red blood cells with increased central pallor (target cells). Serum ferritin is 16μg/L. To determine the cause of anemia, which test should be prioritized?

A 38-year-old male presented with fatigue, sore throat, and low-grade fever for 3 days. He was treated for upper respiratory tract infection (URI) with amoxicillin and herbal medicine for 5 days. The sore throat and fever resolved, but fatigue worsened, accompanied by blurred vision in the left eye, petechiae, and ecchymoses on the trunk and lower limbs. Lab results: WBC 2.5×10⁹/L, Hb 90g/L, PLT 32×10⁹/L. Physical exam: no lymphadenopathy or hepatosplenomegaly, marked sternal tenderness. Bone marrow aspiration showed 89% blast cells with coarse cytoplasmic granules, frequent Auer rods, and strongly positive POX staining. Persistent bleeding at the puncture site. The most likely diagnosis is:

A 25-year-old male presents with hepatosplenomegaly for over 10 years, icteric sclera, occasional right hypochondriac pain, and worsening symptoms over the past 20 days (no fever). Liver is palpable 2 cm below the costal margin; spleen is enlarged 6-7 cm below the costal margin. Hemoglobin (Hb) 110 g/L, reticulocytes 20%, spherocytes 30%, WBC count 8.5×10⁹/L, platelets (PLT) 74×10⁹/L, increased RBC fragility, negative Coombs test, negative Ham test, urine urobilinogen (+), urine bilirubin (-). The diagnosis is:

A 22-year-old female presents with recurrent skin purpura and menorrhagia for 2 years. Physical exam: icteric sclera. Lab results: Hb 70g/L, WBC 5.6×10⁹/L, PLT 20×10⁹/L, reticulocytes 0.25, bleeding time 4 min, poor clot retraction. Coombs test (+), ultrasound shows mild splenomegaly. Bone marrow: erythroid hyperplasia (45%) with increased megakaryocytes (mostly immature/granular forms, few platelet-producing forms). The most likely diagnosis is:

A 21-year-old female was hospitalized with recurrent lower limb purpura, epistaxis, and menorrhagia for 1 year. Laboratory tests: hemoglobin (Hb) 82 g/L, white blood cell (WBC) count 4.2×10⁹/L, platelets (PLT) 26×10⁹/L, reticulocytes 0.16 (16%), direct Coombs test (+), indirect Coombs test (-), antinuclear antibody (ANA) (-). Bone marrow examination showed marked hyperplasia, erythroid series accounted for 0.56 (56%), and 123 megakaryocytes per whole slide, mostly granular type. The most likely diagnosis is:

A 22-year-old female presents with dizziness, fatigue, and jaundice for 2 weeks. Physical examination reveals mild icterus of the sclera and spleen 2 cm below the costal margin. Laboratory tests show hemoglobin (Hb) 65g/L and reticulocytes 0.11 (11%), suggesting hemolysis. Which of the following findings is direct evidence for hemolysis?

A 12-year-old boy is hospitalized with recurrent fever and dark yellow urine for 4 years. Physical exam: mild icterus of the sclera, spleen palpable 3 cm below the costal margin. Laboratory tests: hemoglobin (Hb) 75g/L, reticulocytes 9%, spherocytes with loss of central pallor, urine bilirubin (-), urine urobilinogen strongly positive, normal RBC osmotic fragility test, Rous test (-). Which lab test is most appropriate for definitive diagnosis?

A 32-year-old woman presents with recurrent petechiae on her lower limbs over 2 years, accompanied by intermittent epistaxis and gingival bleeding. Physical exam: scattered petechiae and ecchymoses on lower limbs, no hepatosplenomegaly. Laboratory tests: Hb 110g/L, WBC 5.1×10⁹/L, PLT 35×10⁹/L. Bone marrow smear shows 296 megakaryocytes per slide, with 90% being granular type. The mechanism of thrombocytopenia is:

A 50-year-old male presents with 1 day of diarrhea (3-4 watery stools) after self-administering 6 tablets of furazolidone. The next day, he developed chills, fever, dizziness, and passed tea-colored urine once. Physical exam: severe anemic appearance, icteric sclera, no hepatosplenomegaly. Laboratory tests: Hb 60g/L, reticulocytes 20.1%, positive urine occult blood, positive methemoglobin reduction test. Similar episode occurred 20 years ago after taking sulfonamides for fever, resolved spontaneously in 1 week without treatment. The most likely diagnosis is:

A 28-year-old male presents with dizziness, fatigue, and pallor for over 2 years. Laboratory tests: RBC 3.0×10¹²/L, Hb 70g/L. Blood smear shows hypochromic RBCs with enlarged central pallor and target cells. MCV, MCH, and MCHC are all below normal. Which of the following anemias is LEAST likely?

A 43-year-old male with a history of poor constitution, frequent fever, and multiple drug use presents with tea-colored urine. Laboratory tests: RBC 2.0×10¹²/L, Hb 70g/L, normal white blood cell (WBC) count and platelets (PLT), reticulocytes 12%, positive urine occult blood, serum free hemoglobin 600mg/L. Intravascular hemolysis is diagnosed. Which of the following diseases does NOT typically cause intravascular hemolysis?

A patient with systemic lupus erythematosus (SLE) recently developed anemia and jaundice, with reticulocytes at 0.08, active bone marrow proliferation, and erythroblasts at 0.50. Which test should be prioritized to determine the cause of anemia?

A 22-year-old female presents with recurrent gingival bleeding and menorrhagia for 1.5 years. Examination shows mild anemia, non-palpable liver/spleen, hemoglobin 80 g/L, normal white blood cell (WBC) count, platelets 30×10⁹/L, prolonged bleeding time, hypercellular marrow with erythroid hyperplasia (30%), markedly increased megakaryocytes, and decreased bone marrow iron stores (both intra- and extracellular). The diagnosis is:

A 25-year-old woman presents with recurrent lower limb purpura and menorrhagia for 1 year, with no history of medication use prior to illness. Spleen palpable 1 cm below the costal margin. Hemoglobin (Hb) 105 g/L, white blood cell (WBC) count 5.4×10⁹/L, platelets (PLT) 25×10⁹/L. Erythrocyte sedimentation rate (ESR), urinalysis (UA), and liver function tests are normal. No lupus cells found. Increased granular megakaryocytes with otherwise normal findings. The most likely diagnosis is:

A 25-year-old woman presents with generalized petechiae and ecchymoses for 2 months, and prolonged menstrual bleeding lasting 10 days. Gynecological examination is unremarkable. Laboratory tests: Hb 90g/L (anemia), WBC 6.5×10⁹/L, PLT 32×10⁹/L (thrombocytopenia). Bone marrow shows active proliferation with 218 megakaryocytes per slide, predominantly granular type. After corticosteroid treatment, the most likely prognosis is:

A 26-year-old woman presents with recurrent petechiae and ecchymoses on both lower limbs, accompanied by gingival bleeding over the past 6 months. Laboratory tests show: platelets (PLT) 32×10⁹/L, normal white blood cell (WBC) count and hemoglobin (Hb), elevated platelet-associated immunoglobulins. A diagnosis of primary immune thrombocytopenia (ITP) is considered. Which of the following is NOT consistent with the laboratory findings of this disease?

A 26-year-old female was hospitalized with gingival bleeding and skin ecchymoses for 1 month. Laboratory tests: PLT 28×10⁹/L, Hb 120g/L, WBC 5.6×10⁹/L. Bone marrow smear showed 105 megakaryocytes (15 immature, 80 granular, 8 platelet-producing, 12 naked nuclei). After corticosteroid therapy, bleeding tendency resolved in 1 week, and PLT rose to 126×10⁹/L by 3 weeks. The LEAST likely mechanism of action is:

A 30-year-old woman presents with petechiae, ecchymoses, gum bleeding, and menorrhagia for 1 year. Laboratory tests: platelets 36×10⁹/L, markedly shortened platelet lifespan by isotopic labeling, positive platelet-associated antibody, diagnosed as ITP. Which of the following physical signs should NOT be present?

A 15-year-old male patient developed low-grade fever and rhinorrhea one week ago after catching a cold. After self-administering 'Ganmaotong', he experienced abdominal pain, diarrhea, and bloody stools. The next day, scattered purpura appeared below the knees of both lower limbs. Lab results: Hb 120g/L, WBC 12×10⁹/L (neutrophils 0.8), PLT 160×10⁹/L, urinary protein (+), RBC 10-20/HPF, WBC 5-10/HPF, granular casts 1-2/HPF. What is the most likely diagnosis?

A 29-year-old male presents with dizziness and fatigue for 3 months, scattered petechiae, non-palpable spleen. Lab findings: Hb 80 g/L, WBC 3.5×10⁹/L (neutrophils 35%, lymphocytes 55%), platelets 50×10⁹/L. Acidified serum hemolysis test is negative, and megakaryocytes are absent on bone marrow smear. The most likely diagnosis is:

A 36-year-old male with history of acute icteric hepatitis 6 months ago presents with fever and gingival bleeding for 15 days. Examination shows severe anemic appearance, liver palpable 2 cm below costal margin, spleen just palpable below costal margin. Laboratory tests: RBC 1.8×10¹²/L, Hb 55 g/L, WBC 2.5×10⁹/L, PLT 32×10⁹/L, reticulocytes 0.2%. The most likely diagnosis is:

A 31-year-old woman presents with pallor, gingival bleeding, and menorrhagia for 6 months. Laboratory tests show pancytopenia in peripheral blood, absolute reticulocyte count of 15×10⁹/L. Bone marrow aspiration from the anterior and posterior iliac spines reveals hemodilution, while sternal puncture shows active nucleated cell proliferation dominated by late normoblasts and mature lymphocytes, with no megakaryocytes seen on the slide. The most likely diagnosis is:

A 20-year-old male presents with pallor and fatigue for 3 months. Physical examination reveals scattered petechiae on the skin, no enlarged superficial lymph nodes, no sternal tenderness, and no hepatosplenomegaly. Blood tests show: RBC 2.0×10¹²/L, Hb 60g/L, WBC 3.6×10⁹/L (neutrophils 30%, lymphocytes 70%), PLT 30×10⁹/L, and reticulocytes 0.004. The most likely diagnosis is:

A 50-year-old male presents with fatigue and abdominal distension for 6 months. Physical examination shows anemic appearance and liver palpable 1 cm below the costal margin. Lab results: Hb 70g/L, WBC 250x10⁹/L with predominance of myelocytes and metamyelocytes, PLT 400x10⁹/L. NAP score is reduced. The most likely diagnosis is:

A 30-year-old female presents with fatigue and gingival bleeding for one week, along with recent skin ecchymoses and oozing blood at injection sites. Lab results: hemoglobin (Hb) 70g/L, white blood cell (WBC) count 3.4×10⁹/L, platelets (PLT) 25×10⁹/L; plasma fibrinogen 1.5g/L. Bone marrow shows hypercellularity with 85% abnormal promyelocytes containing coarse azurophilic granules and abundant Auer rods. The primary cause of bleeding is:

A 44-year-old male presents with fever, chills, and myalgia for 1 week, initially treated as a common cold but fever persisted and worsened. Over the past 2 days, he developed gingival bleeding and petechiae. Physical exam: temperature 40°C, clear lungs, spleen 2 cm below the costal margin, sternal tenderness. Lab tests: Hb 68g/L, WBC 46.3×10⁹/L, PLT 36×10⁹/L. Bone marrow examination confirmed acute leukemia. The most likely cause of fever in this patient is:

A 55-year-old male farmer presents to the clinic with fever, dizziness, epistaxis, petechiae, and arthralgia for 2 weeks. Laboratory tests show Hb 70g/L, WBC 31.5×10⁹/L, PLT 20×10⁹/L, and peripheral blood smear with blast cells. Which of the following is the most common and significant physical finding?

A 26-year-old male farmer presents with low-grade fever, poor appetite, and weight loss for 6 months. Physical exam: mild anemic appearance, spleen palpable 3 cm below the umbilicus with right edge extending 2 cm past the midline. Laboratory tests: Hb 90g/L, WBC 262×10⁹/L, PLT 460×10⁹/L, neutrophil alkaline phosphatase (NAP) positivity rate 0.06 (6%), score 8. Bone marrow smear findings are consistent with chronic myeloid leukemia (CML), and cytogenetics shows Ph(+). Which of the following statements about prognosis in this case is INCORRECT?

A 60-year-old male presents with fatigue and tiredness for 6 months, along with low-grade fever and poor appetite for 1 month. Physical examination reveals a mild anemic appearance, multiple bean-sized, hard, non-tender lymph nodes in the neck, non-palpable liver, and spleen 2 cm below the costal margin. Laboratory tests show Hb 81g/L, WBC 4×10⁹/L, PLT 125×10⁹/L, with differential counts of neutrophils 22%, lymphocytes 75%, monocytes 3%, and reticulocytes 12%. Coombs test is positive. The most likely diagnosis is:

A 62-year-old male presents with dizziness and fatigue for 6 months, worsening over the past month, accompanied by low-grade fever and limb soreness. Physical exam: temperature 38°C, severe anemic appearance, petechiae on lower limbs, two peanut-sized palpable cervical lymph nodes, spleen 2 cm below the costal margin. Laboratory tests: Hb 50g/L, WBC 3×10⁹/L, PLT 45×10⁹/L, nucleated red blood cells 3/100 WBC, with macrocytes and giant platelets observed. The most likely diagnosis is:

A 26-year-old male presents with recurrent episodes of cola-colored urine, accompanied by fever, fatigue, and abdominal/lumbar pain, often occurring upon waking. Physical examination shows mild pallor of conjunctiva and nail beds, hepatomegaly (2 cm below costal margin, firm consistency), and splenomegaly (3 cm below costal margin). Which laboratory test is most diagnostic?

A 52-year-old male presents with dizziness, fatigue, and low back pain for 3 months. Laboratory tests show Hb 82g/L, WBC 6.2×10⁹/L, PLT 175×10⁹/L, ESR 116mm/h, urinary protein (+), bone marrow plasma cells 52%, serum protein electrophoresis (SPEP) shows an M-band, and X-ray examination reveals L₂ and L₃ vertebral compression fractures. The most likely diagnosis is:

A 56-year-old male presents with progressive anemia for 1 year and severe low back pain for 3 months. Lab findings: hemoglobin 89g/L, WBC 3.4×10⁹/L, platelets 68×10⁹/L, ESR 180mm/h, urinary protein (++). Bone marrow shows 54% abnormal plasma cells, and serum protein electrophoresis (SPEP) reveals monoclonal protein (M protein). The most likely diagnosis is:

A 60-year-old woman presents with back pain for over 4 months, occasional irregular fever, and urinary frequency with dysuria. Laboratory tests show: urinary protein (+++), white blood cells 5-10 per high power field (HPF), positive Bence Jones protein in urine, and serum protein electrophoresis (SPEP) revealing a monoclonal protein (M protein) of 39.5% between the β and γ regions. The most likely primary diagnosis is:

A 52-year-old male presents with back pain for 6 months and gingival bleeding for 2 weeks. Physical exam: moderate anemic appearance, liver palpable 1cm below the costal margin, spleen just palpable below the costal margin. Laboratory tests: Hb 80g/L, WBC 3.8×10⁹/L, PLT 56×10⁹/L. Urinary protein (+++), ESR 105mm/h, skeletal X-ray shows wedge compression of L₁ and L₃, and moth-eaten destruction of multiple ribs. Serum calcium 3.25 mmol/L, IgG 5.0g/L, IgA 2.1g/L, IgM 0.5g/L, IgD 0.003g/L, urine Bence Jones protein (-). What is the most likely diagnosis?

A 56-year-old male presents with lower back pain for over 6 months, accompanied by irregular fever, urinary frequency, and dysuria. Laboratory tests show: urinary protein (+++), white blood cell (WBC) count 10-15/HPF, positive Bence Jones protein in urine. Serum protein electrophoresis (SPEP) reveals a monoclonal protein (M protein) of 0.395 (39.5%) between β and γ regions. A provisional diagnosis of multiple myeloma (MM) is made. Which of the following laboratory findings is most definitive for confirming the diagnosis?

A patient developed symptoms in May, 2 days after consuming 5 fresh fava beans, with sudden onset of systemic discomfort, fatigue, low-grade fever, vomiting, abdominal pain, severe anemia, marked jaundice, and hemoglobinuria. The diagnosis should be:

A 60-year-old woman presents with irregular fever, low back pain, and facial edema for 5 months. Laboratory tests show: urinary protein (+++), WBC 5-10/HPF, positive Bence Jones protein in urine. Bone marrow aspiration reveals 20% myeloma cells (large cells with prominent nucleoli, including binucleated and trinucleated plasma cells). Diagnosis: multiple myeloma (MM). Which of the following tests is NOT relevant to MM staging?

A 53-year-old male presents with dizziness, fatigue, limb numbness, and unsteady gait for over 6 months. He underwent total gastrectomy 8 years ago due to gastric bleeding. Laboratory tests: RBC 2.1×10¹²/L, Hb 72g/L, WBC 3.2×10⁹/L, PLT 86×10⁹/L, MCV 140fl (140μm³), MCH 42pg, serum vitamin B₁₂ 86pg/ml (normal: 200-900pg/ml), normal folate. The diagnosis is vitamin B₁₂ deficiency anemia. The most likely cause is:

A 57-year-old male presents with painless progressive enlargement of bilateral cervical lymph nodes for over 1 month, accompanied by intermittent irregular fever exceeding 38°C. Physical examination reveals one 3cm×2cm enlarged lymph node in each cervical region, and one 2cm×1cm enlarged lymph node in the left axilla and right groin, all mobile with no tenderness. Hodgkin lymphoma is clinically suspected. The best diagnostic method to confirm the diagnosis is:

A 35-year-old male presents with high fever and pruritus (skin itching) for half a month, along with right cervical and supraclavicular lymphadenopathy (enlarged lymph nodes) that is adherent to each other and shows no tenderness. Lab results: hemoglobin (Hb) 90g/L, white blood cell (WBC) count 10×10⁹/L (neutrophils 66%, lymphocytes 24%). Bone marrow smear reveals Reed-Sternberg cells (R-S cells). The most likely diagnosis is:

A 32-year-old male factory worker presents with irregular fever for over 2 months, accompanied by decreased appetite, weight loss, and night sweats. Physical examination reveals mild icterus of the sclera, three peanut-sized hard cervical lymph nodes with no tenderness, and two bean-sized inguinal lymph nodes on the right side. The spleen is palpable 2 cm below the costal margin. Laboratory tests show Hb 79g/L, reticulocytes 8%, total bilirubin 50μmol/L (direct bilirubin 12μmol/L), urine urobilinogen 1:160 positive, and urine bilirubin negative. Malignant lymphoma is suspected. The most appropriate diagnostic method is:

A 35-year-old male with cirrhosis and esophageal variceal bleeding undergoes blood transfusion. Approximately 5 minutes after starting the transfusion, he suddenly develops restlessness, chills, chest tightness, severe back pain, cyanosis, and dyspnea, prompting immediate cessation of the transfusion. The most likely transfusion reaction is:

A 52-year-old male presents with gradually enlarging neck masses over 3 months and intermittent fever with pruritus for 1 month. On examination: temperature 38.9°C, multiple pea-to-bean-sized enlarged lymph nodes in bilateral cervical, supraclavicular, and left axillary regions, some matted, firm consistency, no tenderness. Left cervical lymph node biopsy confirms Hodgkin lymphoma. The most common initial symptom in such patients is:

A 26-year-old male farmer is admitted with fever and cough for 2 weeks, and epistaxis, gingival bleeding, and extensive ecchymoses for 3 days. Physical exam: moderate anemic appearance, marked tenderness over the mid-sternum, spleen palpable 1 cm below the costal margin, and large ecchymoses on the arms and buttocks. Laboratory tests: Hb 72g/L, WBC 3.8×10⁹/L, PLT 34×10⁹/L, prothrombin time 16 sec (normal control 12 sec), fibrinogen 1.2g/L, urine RBC (++). The most likely cause of bleeding in this case is:

A 45-year-old male with a 10-year history of chronic liver disease is hospitalized for recurrent gingival bleeding, epistaxis, and purpura over the past 6 months. Physical exam: dusky complexion, palmar erythema and spider angiomas, scattered petechiae and ecchymoses on the skin. Liver not palpable below the costal margin, spleen palpable 4.5 cm below the costal margin. Ascites sign (-). Which of the following coagulation tests is most likely to show the earliest abnormality?

A 16-year-old male patient presents with persistent bleeding after tooth extraction. The patient has normal development and weighs 58kg. Laboratory tests show normal bleeding time (BT), normal prothrombin time (PT), and significantly prolonged activated partial thromboplastin time (APTT). The abnormality is corrected by barium sulfate-adsorbed plasma but not by normal human serum. The most likely diagnosis is:

A 48-year-old male presents with dizziness, fatigue, and lower extremity edema for 3 months, and palpitations/dyspnea when climbing 3 flights of stairs for 2 weeks. Physical exam: severe anemic appearance, heart rate 120 bpm, grade III systolic murmur at apex, no hepatosplenomegaly. Lab: hemoglobin 66g/L, hematocrit 0.20 (20%). What is the FIRST outpatient test for this patient?

A 56-year-old male presents with decreased appetite and epigastric pain for 6 months, along with 8 kg weight loss. Hb is 80 g/L, RBC count 3.1×10¹²/L, and reticulocytes 2%. Bone marrow shows hypercellular erythroid lineage with predominance of intermediate and late normoblasts, which are small in size, have scant cytoplasm, and irregular borders. Myeloid and megakaryocytic lineages are normal. The most likely diagnosis is:

A 68-year-old woman with atrophic gastritis and pernicious anemia for over 10 years has been receiving monthly vitamin B₁₂ injections for the same duration. Over the past month, she has experienced fatigue upon exertion. Laboratory results show hemoglobin 90g/L, mean corpuscular hemoglobin concentration (MCHC) 26%, mean corpuscular volume (MCV) 67fl, reticulocyte count 0.6%, and serum ferritin 13μg/L. The most likely diagnosis is:

A 35-year-old woman underwent partial gastrectomy 10 years ago due to gastric bleeding. Over the past year, she has complained of dizziness, fatigue, and pallor. Laboratory tests show: RBC 3.2×10¹²/L, Hb 70g/L, normal WBC and PLT counts, reticulocytes 0.015 (5%). Bone marrow examination reveals marked erythroid hyperplasia, predominantly intermediate and late normoblasts. These cells are small with scant basophilic cytoplasm and irregular margins. Which of the following is most likely observed in serum iron studies?

A 25-year-old male farmer presents with pallor and fatigue for one year. Blood tests show RBC: 2.0×10⁹/L, Hb: 50g/L, WBC: 7.6×10⁹/L, neutrophils: 0.50, lymphocytes: 0.26, eosinophils: 0.14, serum ferritin: 10μg/L, and increased central pallor of red blood cells on peripheral smear. A diagnosis of iron-deficiency anemia is made. The patient is treated with ferrous sulfate 0.3g three times daily orally for one month but shows poor response. The most likely reason is:

A 42-year-old woman with menorrhagia for over 3 years and dizziness, fatigue, palpitations, and shortness of breath on exertion for 6 months. Gynecological examination revealed uterine fibroids (leiomyomas). Laboratory tests: RBC 2.5×10¹²/L, Hb 50g/L, WBC 5.2×10⁹/L, PLT 201×10⁹/L, increased central pallor of red blood cells, serum ferritin 9μg/L. Diagnosed with iron deficiency anemia. Which of the following findings on bone marrow smear is NOT consistent with iron deficiency anemia?

A 30-year-old male with a 10-year history of recurrent epigastric pain presents with 3 days of melena, dizziness, fatigue, and palpitations. Emergency gastroscopy reveals a postbulbar duodenal ulcer with active bleeding. Laboratory tests: RBC 2.8×10¹²/L, Hb 63g/L, WBC 12×10⁹/L, PLT 110×10⁹/L, reticulocytes 0.02 (2%). Which of the following tests is most reliable for determining the etiology of anemia?

A 15-year-old male patient has had anemia and jaundice for 5 years, with a spleen palpable 2.5 cm below the costal margin. Hb is 75 g/L, reticulocytes 0.06, and normal white blood cell (WBC) and platelet (PLT) counts. Bone marrow shows marked hyperplasia with erythroid predominance. Red cell osmotic fragility test reveals hemolysis initiation in 0.70% saline solution. His father also has mild anemia and jaundice. The most likely diagnosis is:

A 34-year-old male presents with dizziness and fatigue for more than 2 years, worsened with jaundice for 1 month. Lab results: Hb 50g/L, WBC 3.0×10⁹/L, platelets 48×10⁹/L, reticulocyte count 0.20 (20%), bone marrow smear showing active proliferation (erythroid series 53%, predominantly intermediate and late normoblasts), urine bilirubin negative, urine urobilinogen 1:320 positive, urine hemosiderin positive, serum ferritin 12 μg/L. The most likely diagnosis is:

A 61-year-old male presents with anorexia, nausea, dizziness, fatigue, and generalized jaundice for 1 month. Laboratory tests: Hb 80g/L, reticulocyte count 0.20 (20%), peripheral smear shows spherocytes 0.06 (6%), slightly increased RBC osmotic fragility, urine bilirubin (-), urine urobilinogen strongly positive, urine occult blood (-), serum total bilirubin (TBil) 76.15 μmol/L, direct bilirubin 6.84 μmol/L, ALT <40 U/L. A diagnosis of hemolytic anemia is suspected. Which of the following laboratory tests should be performed first to determine the etiology of hemolysis?

A 22-year-old woman has experienced heavy menstrual bleeding for 2 years and developed skin petechiae and gingival bleeding in the past 2 weeks. Physical exam: mild anemic appearance, non-palpable spleen. Lab results: Hb 76g/L, WBC 4.2×10⁹/L, PLT 25×10⁹/L. Bone marrow shows active proliferation with 100 megakaryocytes but decreased platelet-producing forms. The diagnosis is:

A 43-year-old female is diagnosed with idiopathic thrombocytopenic purpura (ITP), with platelet count 11×10⁹/L. What is the first-line treatment for this patient?

A 55-year-old female diagnosed with idiopathic thrombocytopenic purpura (ITP) has been treated with prednisone for 1 year. Her platelet count remains at 20×10⁹/L while still taking prednisone 30mg/day. The next step in management is:

A 26-year-old female presents with recurrent purpura on both lower limbs and increased menstrual bleeding for 1 year. Spleen is just palpable below the costal margin. No prior medication history. WBC 9.6×10⁹/L, Hb 101g/L (anemia), PLT 24×10⁹/L. Bone marrow shows active proliferation with 75 megakaryocytes. ESR, urinalysis (UA), liver and renal function are normal. The most likely diagnosis is:

A 30-year-old female presents with heavy menstrual bleeding for 3 years and skin purpura for one week. Physical examination reveals scattered petechiae on both lower limbs with no sternal tenderness. No hepatosplenomegaly or lymphadenopathy. Lab results: Hb 110g/L, WBC 4.6×10⁹/L, PLT 30×10⁹/L. Bone marrow shows active nucleated cell proliferation with normal granulocytic and erythroid series. Megakaryocytes: 116 (granular type 0.88, naked nuclei 0.12), no platelet-producing megakaryocytes. The most likely diagnosis is:

A 30-year-old woman presents with recurrent petechiae, ecchymoses, and menorrhagia for 6 months. Physical exam shows mild anemic appearance, non-palpable liver/spleen, petechiae, and multiple ecchymoses on lower limbs. CBC reveals Hb 86g/L (anemia) and WBC 6.5×10⁹/L. Which additional test should the outpatient doctor order?

A 22-year-old female patient presents with menorrhagia for 8 months, gingival bleeding for 2 weeks, and scattered petechiae and ecchymoses on the lower limbs. Outpatient tests show hemoglobin 80 g/L, WBC 5.2×10⁹/L, and platelets 32×10⁹/L. Gynecological examination is unremarkable. Which of the following laboratory findings is direct evidence for diagnosing idiopathic thrombocytopenic purpura (ITP)?

A 45-year-old woman with anemia for 1 year. Liver barely palpable below the costal margin, spleen not palpable. Hemoglobin 60 g/L, RBC 2.10×10¹²/L, WBC 3.2×10⁹/L (neutrophils 38%, lymphocytes 62%), no immature RBCs, platelets 50×10⁹/L. Bone marrow shows only 1 megakaryocyte per slide, elevated neutrophil alkaline phosphatase score, active bone marrow proliferation with predominantly late-stage granulocytic and erythroid series, and negative Ham test. The most likely diagnosis is:

A female patient presents with acute onset of progressively worsening symptoms including pallor, fatigue, marked shortness of breath, frequent fever (temperature 39°C), susceptibility to colds, and petechiae. Blood tests show severe pancytopenia with severe normocytic hypochromic anemia and WBC count <2×10⁹/L. Bone marrow biopsy reveals severe hypoplasia. The diagnosis is:

A 15-year-old male presents with chills, high fever for 3 days, accompanied by epistaxis and oral ulcers. Physical examination reveals scattered petechiae over the body, no enlargement of superficial lymph nodes, no sternal tenderness, and no hepatosplenomegaly. Blood tests show: Hb 100 g/L, WBC 1.0×10⁹/L (neutrophils 0.15, lymphocytes 0.85), PLT 12×10⁹/L, and reticulocytes 0.001. The most likely diagnosis is:

A 19-year-old male presents with dizziness, fatigue, and pallor for 1 year, along with gingival bleeding and petechiae for 1 month. Laboratory tests show Hb 60g/L, WBC 3.2×10⁹/L, PLT 30×10⁹/L, and bone marrow smear confirms aplastic anemia. What is the first-line treatment for this case?

A 30-year-old male patient was admitted with persistent high fever, sore throat, and gingival bleeding for 1 week. Physical exam: temperature 40°C, pallor, marked pharyngeal congestion, mucosal ulceration, disseminated petechiae, no palpable lymph nodes, no hepatosplenomegaly, no sternal tenderness. Lab results: RBC 1.5×10¹²/L, Hb 46g/L, WBC 2.4×10⁹/L (N 20%, L 75%, M 5%), PLT 19×10⁹/L, reticulocytes 0.1%. The most likely diagnosis is:

A 55-year-old male presents with fatigue, weight loss, and abdominal distension for over 6 months. Physical examination reveals liver 2 cm below the costal margin and spleen palpable at the umbilicus. Lab results: Hb 100g/L, WBC 110×10⁹/L, PLT 98×10⁹/L. Blood differential: myeloblasts 5%, promyelocytes 3%, myelocytes 10%, metamyelocytes 12%. The most likely diagnosis is:

A 68-year-old male presents with fever for 1 week. Physical examination shows anemic appearance, no hepatosplenomegaly or lymphadenopathy. Lab results: hemoglobin 80 g/L, WBC count 2×10⁹/L, platelets 45×10⁹/L. Bone marrow examination reveals 50% myeloblasts. The treatment of choice is:

A 30-year-old female presents with fatigue and gingival bleeding for one week, along with skin ecchymoses and oozing blood at injection sites over the past 2 days. Lab findings: Hemoglobin (Hb) 70g/L, white blood cell (WBC) count 3.4×10⁹/L, platelets (PLT) 25×10⁹/L; plasma fibrinogen 1.5g/L. Bone marrow biopsy shows hypercellularity with 85% abnormal promyelocytes containing coarse azurophilic granules and frequent Auer rods. The preferred treatment regimen is:

A 33-year-old male presents with fever for 1 week, accompanied by epistaxis, gingival bleeding, subconjunctival hemorrhage, and large ecchymoses at injection sites. Stool is purplish-red. Laboratory tests: Hb 85g/L, WBC 1.5×10⁹/L, PLT 53×10⁹/L. Bone marrow examination shows markedly hypercellular nucleated cells with blast cells accounting for 85%. POX strongly positive. Chromosomal analysis reveals t(15;17). The most likely cause of bleeding in this case is:

A 44-year-old male presents with fever, chills, and myalgia for 1 week, initially treated as a common cold but with worsening fever. Over the past 2 days, he developed gingival bleeding and petechiae. Physical exam: temperature 40°C, clear lung auscultation, spleen 2 cm below the costal margin, and sternal tenderness. Laboratory tests: Hb 68g/L, WBC 46.3×10⁹/L, PLT 36×10⁹/L. Bone marrow examination confirms acute leukemia. The most appropriate management at this time is:

A 21-year-old female presents with irregular fever for half a month, accompanied by fatigue and weight loss. Physical examination reveals multiple pea-to-bean-sized, hard, non-tender lymph nodes in bilateral cervical, supraclavicular, and axillary regions. Liver is palpable 1 cm below the costal margin, and spleen is palpable 3 cm below the costal margin, both of medium consistency and non-tender. Laboratory tests: hemoglobin (Hb) 80 g/L, white blood cell count (WBC) 4.2×10⁹/L, platelet count (PLT) 70×10⁹/L, reticulocytes 0.11 (11%), Coombs test (+). During lymph node biopsy, Reed-Sternberg cells are found. These cells may be seen in all of the following conditions EXCEPT:

A 68-year-old male presents with fever for 1 week. Physical examination shows anemic appearance, no hepatosplenomegaly or lymphadenopathy. Lab results: WBC 2×10⁹/L, hemoglobin 80 g/L, platelets 45×10⁹/L. Bone marrow examination reveals 50% myeloblasts. The treatment of choice is:

A 55-year-old male farmer presents with fever, dizziness, epistaxis, petechiae, and arthralgia for 2 weeks. Laboratory tests show: Hb 70g/L, WBC 31.5×10⁹/L, PLT 20×10⁹/L, and peripheral blood smear with blast cells. The most important diagnostic test is:

A 38-year-old female patient presents to the outpatient department with a 2-month history of abdominal distension in the left upper quadrant, poor appetite, weight loss, fatigue, and night sweats. Physical examination reveals a mild anemic appearance, mild sternal tenderness, and splenomegaly (5 cm below the costal margin). Laboratory tests show a white blood cell (WBC) count of 250×10⁹/L with numerous myelocytes and metamyelocytes on differential. Bone marrow examination confirms chronic myeloid leukemia (CML). What is the most appropriate treatment for this confirmed CML case?

A 55-year-old male presents with poor appetite, fatigue, and weight loss for 6 months. Physical exam: dark red facial complexion, liver palpable 1 cm below the costal margin, spleen palpable 5 cm below the costal margin, firm with no tenderness. Laboratory tests: Hb 195g/L, WBC 16.2×10⁹/L, PLT 450×10⁹/L, hematocrit 0.60 (60%). Bone marrow smear shows marked hyperplasia with trilineage proliferation (granulocytic, erythroid, megakaryocytic) and normal cell morphology. A myeloproliferative disorder is diagnosed. The most likely diagnosis is:

A 62-year-old male presents with dizziness and fatigue for 6 months, worsening over the past month, accompanied by low-grade fever and limb soreness. Physical examination: temperature 38°C, severe anemic appearance, petechiae on lower limbs, two peanut-sized palpable cervical lymph nodes, spleen 2 cm below the costal margin. Laboratory tests: Hb 50g/L, WBC 3×10⁹/L, PLT 45×10⁹/L, blood smear shows nucleated red blood cells (3/100 WBC), macrocytes, and giant platelets. The most critical diagnostic test is:

A 52-year-old male presents with dizziness, fatigue, and low back pain for 3 months. Laboratory tests show Hb 82g/L, WBC 6.2×10⁹/L, PLT 175×10⁹/L, ESR 116mm/h, urinary protein (+), bone marrow plasma cells 52%, M-band on serum protein electrophoresis (SPEP), and L₂/L₃ vertebral compression fractures on X-ray examination. Which of the following is LEAST likely to be found?

A 60-year-old woman presents with back pain for over 4 months, occasional irregular fever, and urinary frequency with dysuria. Laboratory tests show: urinary protein (+++), white blood cells 5-10 per high power field (HPF), positive Bence Jones protein in urine, and serum protein electrophoresis (SPEP) revealing an M protein (39.5%) between β and γ regions. Which finding would most confirm the diagnosis?