Sam is an 18-year-old African American male. Over the past week noted increasing fatigue, sore throat, earaches, headaches, and episodic fever and chills. Unable to run his customary 25 miles per week. Physical Exam Erythematous throat and tonsils. Swollen cervical lymph nodes. CBC (with microscopic differential) RBC ,5.25 times (10^(12))/(L) HGB,1

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Sam is an 18-year-old African American male. Over the past week noted increasing fatigue, sore throat, earaches, headaches, and episodic fever and chills. Unable to run his customary 25 miles per week. Physical Exam Erythematous throat and tonsils. Swollen cervical lymph nodes. CBC (with microscopic differential) RBC

,5.25\times (10^(12))/(L)

HGB,15.4(g)/(d)L

HCT

,46.1%

MCV,87.9fL

MCH,29.3pg

MCHC,33.4(g)/(d)L

RDW

,12.2

WBC

,12.9\times (10^(9))/(L)

N,24%

L (shown) 73

M,0

E

,3

B

,0

PLT

,333\times (10^(9))/(L)

This is seen on manual differential. a. What morphologic alterations are seen in this blood smear field? b. What further laboratory studies, if any, are indicated? c. What is the most likely diagnosis?

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