Per First Aid 2018 (pg 421) & Merck Manual

a) CML is not the answer because in CML you have HIGH WBCs & Platelets. In the stem there is only high platelets. b) Is the answer because in Essential Thrombocythemia we have normal WBCs and RBCs, just high platelets. c) Myeloid metaplasia refers to well a metaplasia in myeloid cells which are basophils, eosinophils, etc. d) In Polycythemia Vera we have HIGH RBCs, WBCs, and Platelets. e) Reactive thrombocytosis- is a elevated platelet count that occurs secondary to another disorder like:

-Chronic inflammatory disorders (eg, rheumatoid arthritis, inflammatory bowel disease, tuberculosis, sarcoidosis, granulomatosis with polyangiitis) -Acute infection

-Hemorrhage

-Iron deficiency

-Hemolysis

-Cancer

-Splenectomy or hyposplenism

Just want to add that the pale, blue mottled finger is a symptom of essential thrombocythemia called erythromelalgia. Also a symptom in Polycythemia Vera but this dudes erythrocyte count is normal.

Take a look at that massive platelet count -- over a million per mm3! That should point you towards a myeloproliferative disorder of some sort since this fella isn't bleeding out as far as we can tell from the blood panel (which would put reactive thrombocytosis on the ddx).

Now let's look at those erythrocytes. Normal -- so it's not polycythemia vera, and considering the lack of leukocytosis, probably not CML or myeloid metaplasia.

So our answer must be essential thrombocythemia!

FA 2017: Characterized by massive proliferation of megakaryocytes and platelets. Symptoms include bleeding and thrombosis. Blood smear shows markedly increased number of platelets, which may be large or otherwise abnormally formed. Erythromelalgia may occur.

Essential thromcythemia is a neoplastic proliferation of mature myeloid cells, especially platelets.

High neutrophils and eosinophils