For the past 4 months, a 62-
year-old previously healthy man has noted increasing fatigue and shortness of breath with minimal exercise. He has felt some abdominal discomfort over the past month. On physical examination he has non- tender cervical lymphadenopathy. The liver span is 15 cm in the right mid-clavicular line: the edge is smooth and palpable just below right costal margin.
The spleen is palpated 3 cm below left costal margin on inspiration. A CBC shows WBC count 23.100/microliter with 16 neutrophils, 2 bands, 78 lymphocytes, and 4 monocytes, Hgb 11.9 g/dL, Hct 36%, MCV 90, and platelet count 277,300/microliter. The direct Coombs test is positive.
Which of the following is the ?most likely diagnosis
a.leukemoid reaction
b.Acute myelogenous leukemia
c.Chronic myelogenous leukemia
d.Chronic lymphocytic leukemia