Results of the initial investigations:

FBC 105 g/l

WCC 6.0×10*9/l

Platelet count 70 x10*9

MCV 82 FL

HCT 0.39

Neutrophil 1.0 x10*9/l

Lymphocytes 4.0×10*9/l

Eosinophils 0.6×10*9/l

Monocytes 0.2*10*9/l

Basophils 0.1×10*9/l

Large unstained cells 0.8×10*9

Small section of blood film shown above!

U&Es normal

GGT – 98 (0-45U/L)

ALP – 56 (30-120 U/L)

ALT 65 (0-45U/L)

Ca – 2.4 (2.2-2.6mmol/L)

HIV negative

autoimmune screen and viral serology will take a few more days!

USS (organised quicker than CT) confirms splenomegaly – spleen measures 18x10x7cm with a normal architecture.

What are your thoughts now?  further investigations?  referrals to other team?

What  cautions should you take with this patient?