Case Study: 44-Year-Old Man with Fever, Abdominal Pain, and Pancytopenia
A 44-year-old man presents with fever, abdominal pain, and fatigue. His physical examination shows splenomegaly. His laboratory results are as follows:
White blood cells 2.0 K/μL (4.0-11.0 K/μL)
Hemoglobin 7.6 g/dL (13.5-17.5 g/dL)
Platelets 65 K/μL (150-400 K/μL)
Aspartate aminotransferase 634 U/L (11-47 U/L)
Alanine aminotransferase 164 U/L (7-53 U/L)
Alkaline phosphatase 221 U/L (38-126 U/L)
Total bilirubin 4.6 mg/dL (0.3-11 mg/dL)
Direct bilirubin 3.1 mg/dL (0-0.3 mg/dL)
Fibrinogen 100 mg/dL (170-400 mg/dL)
Ferritin 123,000 ng/mL (22-322 ng/mL)
The patient is transfused several units of packed red blood cells without significant correction of his anemia, and instead, his pancytopenia worsens. Peripheral smear shows pancytopenia without blasts, tear drop cells or dysplasia. A bone marrow biopsy demonstrates the following figures.
What is the most likely diagnosis for the patient’s pancytopenia?