question: Q:A 70-year-old woman presents with a 2-week history of severe fatigue. Over the past month, she has unintentionally lost 2 kg (4.4 lb). Three years ago, she was diagnosed with myelodysplastic syndrome. Currently, she takes no medications other than aspirin for occasional knee pain. She does not smoke or drink alcohol. Her vital signs are within the normal range. On physical examination, her conjunctivae are pale. Petechiae are present on the distal lower extremities and on the soft and hard palates. Palpation reveals bilateral painless cervical lymphadenopathy. Examination of the lungs, heart, and abdomen shows no abnormalities. Laboratory studies show:
  Hemoglobin 9 g/dL
  Mean corpuscular volume 90 μm3
  Leukocyte count 3000/mm3
  Platelet count 20,000/mm3
  A Giemsa-stained peripheral blood smear is shown in the image. Which of the following best explains these findings?? 
  {'A': 'Acute myeloid leukemia', 'B': 'Aplastic anemia', 'C': 'Chronic myelogenous leukemia', 'D': 'Hairy cell leukemia', 'E': 'Primary myelofibrosis'},