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: Medicine
All of the following conditions are associated with PNH, EXCEPT: 
Select and explain. 
A. Pancytopenia, B. Cerebral thrombosis, C. Budd chiari syndrome, D. Massive splenomegaly
D: Massive splenomegaly
Answer: D: Massive splenomegaly 
Explanation: PNH is not usually associated with a massive splenomegaly. Complications of paroxysmal nocturnal hemoglobinuria includes thrombosis (mesentric, cerebral or hepatic vein), infection secondary to neutropenia, hemorrhage secondary to thrombocytopenia. It can also evolve into aplastic anemia, and rarely into acute myeloid leukemia. Thrombosis is one of the most immediately life-threatening complications of PNH which could be due to deficiency of CD59 on the PNH platelet causing inappropriate platelet activation. Ref: Harrison's Internal Medicine, 18th Edition, Chapter 106