A 44-year-old man was presented to the clinic with fever, abdominal pain, and fatigue. His physical examination showed splenomegaly and his laboratory results are given below: White blood cells 2.0 K/μL (4.0-11.0 K/μL) Hemoglobin 7.6 g/dL (13.5-17.5 g/dL) Platelets 65 K/μL (150-400 K/μL) Aspartate aminotransferase 634 U/L (11-47 U/L) Alanine aminotransferase 164 U/L (7-53 U/L) Alkaline phosphatase 221 U/L (38-126 U/L) Total bilirubin 4.6 mg/ dL (0.3-11 mg/ dL ) Direct bilirubin 3.1 mg/dL (0-0.3 mg/dL) Fibrinogen 100 mg/dL (170-400 mg/dL) Ferritin 123,000 ng/mL (22-322 ng/mL) He was transfused several units of packed red blood cells without significant correction of his anemia, and instead, his pancytopenia got worse. Peripheral smear shows pancytopenia without blasts, tear drop cells, or dysplasia.
Image of his bone marrow biopsy is attached. What could be the most likely diagnosis?…
