This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Pathology
[{'content': 'A patient with Hb-6 gm%, TLC 1200, platelet-60,000, MCV-12 fl, what is the diagnosis? \nSelect and explain. \nA. Aplastic anemia, B. Megaloblastic anemia, C. PNH, D. Myelofibrosis', 'role': 'user'}, {'content': 'Answer: D \nExplanation: The ﬁndings in the given question are: Anemia (Hb = 6 gm%), Reduced leukocyte count (TLC=1200), Reduced platelet count (60000), Reduced MCV (12 fL).\nNormal value of MCV is 80-100 fL. It is the measure of size of RBC. Reduced MCV means microcytic and increased MCV means macrocytic RBCs. Normal TLC is 4000-11000, normal platelet count is\xa01,50,000 to 4,50,000 and normal Hb is above 12 g/dL.\nNow, considering the options one by one:\n\nAplastic anemia has reduced RBC, WBC as well as platelet counts. Anemia is normocytic normochromic, thus it can be easily ruled out.\nParoxysmal nocturnal hemoglobinuria (PNH) typically presents with anemia which is usually normocytic normochromic.\n\nIf MCV is high, it is due to reticulocytosis. Neutropenia and thrombocytopenia may or may not be present.\nTherefore, this option also cannot be the answer.\n\nMegaloblastic anemia presents with raised MCV. There may be leukopenia as well as thrombocytopenia. Severity of these changes parallels the degree of anemia.\nMyeloﬁbrosis usually presents with anemia, leukopenia and thrombocytopenia. Mostly anemia is normocytic but in 30% cases, microcytic anemia can be present.\n\nBased on the above discussion, the most probable answer is ‘Myeloﬁbrosis’.\nHowever, the value of MCV given is 12 fL which is practically not possible. Normal value of MCV is 80-\xa0100 fL. MCV < 50 fL is considered to be extremely low. Therefore, one possibility is that it may be 112\xa0fL and due to typographical error in the question, written as 12 fL. If this is the case, then the answer will become megaloblastic anemia.', 'role': 'assistant'}]