Approach to myelodysplastic syndromes Quiz: Ace Your Exams

A 65-year-old man presents to the primary care clinic for his yearly examination. Since being seen last year, the patient has become progressively more fatigued and experiences shortness of breath with exertion. He was hospitalized four times in the past year for three episodes of pneumonia and one episode of left leg cellulitis. The patient has noticed easy bruising and frequent bleeding when brushing his teeth and shaving. Two weeks ago, he developed a small wound on his right forearm, and it took over one week to start healing. The patient has a history of paroxysmal atrial fibrillation and takes metoprolol and warfarin. Vital signs show mild tachycardia. On physical examination, there is conjunctival pallor. There are diffuse scattered petechiae and small ecchymoses on skin examination and a 2 cm healing wound on the right forearm. Which of the following is the most likely diagnosis?