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A 65-year-old man has malaise, fatigue, epistaxis, and pruritus. His pruritus is exacerbated by a hot shower. The patient has never smoked and there is no history of lung disease. Physical examination reveals profound splenomegaly. On laboratory examination, his hematocrit is found to be 57% and his red cell mass is elevated. Erythropoietin levels are low. Peripheral blood smear shows normal RBCs. Which of the following provides the best initial therapeutic option?
A. Administer erythropoietin
B. Bone marrow transplantation
C. Exchange transfusion
D. Myelosuppressive agents
E. Serial phlebotomy

E.

E is correct....good job seagapoo.

Thanks for great qs..GL

e...

yes E...