: 23. A 58-year-old man comes to the physician because of a 1-month history of fatigue. He recently returned from a 6-month stay in Acapulco, Mexico. His temperature is 37.8°C (100F), pues 80/min, respirations are 17/min, and blood pressure is 130/83 mm Hg. Physical examination shows massive splenomegaly, Laboratory studies show Hemoglobin 13.4 g/L Hematocrit 39.8% Mean corpuscular volume 88.3 m Loukocyte count 131.000 mm Platelet count 346.000/mm Red cell distribution width 19.3% (N=13%-15%) Aphotomicrograph of a peripheral blood smear is shown. Which of the following is the most likely cause of these findings? A) Acute lymphocytic leukemia 8) Chronic myelogenous leukemia C) Entamoebe histolytica infection D) Plasmodium wvax infection Sickle cell disease
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