A 63-year-old man is brought to the physician because of a 2-week history of a sensation of fullness in the left upper quadrant of the abdomen He also has had lethargy and occasional shortness of breath during this period, He has a 9-kg (20-1b) weight loss during the past 3 months.
Physical examination shows pallor.
The spleen tip is palpated, Laboratory studies show:
Hematocrit 27% .
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