Which one of the labeled boxes in the diagram below is most consistent with the expected findings for an individual with polycythemia rubra vera?
) Polycythemia rubra vera (PRV) is a myeloproliferative disorder that is characterized by excessive proliferation of erythroid, granulocytic, and megakaryocytic precursors derived from a single stem cell. In PRV the erythroid series dominates, but there is hyperplasia of all elements. There is plethoric congestion of all organs. The liver and spleen are typically moderately enlarged and may show extramedullary hematopoiesis. Thrombotic complications are an impoant cause of morbidity and moality, and major and minor hemorrhagic complications are also frequent. The red cell count is elevated with hematocrit >60% (despite the fact that serum erythropoietin levels are decreased). The white cell count and platelet count are also elevated. Leukocyte alkaline phosphatase (LAP) activity is elevated, in contrast to the case with chronic myeloid leukemia, where it is reduced. Pruritus and peptic ulceration are common, possibly in relation to increased histamine release from basophils Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition.
Box A
Box B
Box D
Box E
miscellaneous