<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 67-year-old man comes to the physician because of a 2-month history of generalized fatigue. On examination, he appears pale. He also has multiple pinpoint, red, nonblanching spots on his extremities. His spleen is significantly enlarged. Laboratory studies show a hemoglobin concentration of 8.3 gdL, a leukocyte count of 81,000mm3, and a platelet count of 35,600mm3. A peripheral blood smear shows immature cells with large, prominent nucleoli and pink, elongated, needle-shaped cytoplasmic inclusions. Which of the following is the most likely diagnosis?? A: Myelodysplastic syndrome, B: Acute lymphoblastic leukemia, C: Acute myelogenous leukemia, D: Chronic myelogenous leukemia, E: Hairy cell leukemia,  <response>: Based on the symptoms of fatigue, pallor, enlarged spleen, low hemoglobin, high leukocyte count, low platelet count, and immature blood cells with cytoplasmic inclusions on the peripheral smear, this patient most likely has acute leukemia. The prominent nucleoli and cytoplasmic inclusions point towards acute myelogenous leukemia rather than acute lymphoblastic leukemia. The lack of Philadelphia chromosome and increased basophils makes chronic myelogenous leukemia unlikely. Hairy cell leukemia is a chronic B cell leukemia that would not present with these findings.C: Acute myelogenous leukemia 