A 55-year-old male presents to his primary care physician fo…
A 55-year-old male presents to his primary care physician for fatigue. He states he has not felt like himself recently and had to take a few days off of work secondary to fatigue. He has lost 10 pounds over the past month. Vital signs: T: 99.0°F (37.2°C), BP:128/65 mmHg, HR: 100/min, RR: 12/min, and oxygen saturation is 98% on room air. Laboratory values are ordered as seen below.Hemoglobin: 9 g/dLHematocrit: 27%Leukocyte count: 2,500 with normal differentialPlatelet count: 93,000A biopsy of the bone marrow is performed which demonstrates hypocellular and fibrotic bone marrow and a peripheral smear is performed (see image). Which of the following is the most likely diagnosis?