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Most of the team have decided that this is a reactive thrombocytosis. The film shows left shift neutrophils and thrombocytosis and the other parameters in the full blood count are not worrying (raised haematocrit/basophilia/eosinophilia). The patient is diagnosed with a reactive thrombocytosis, likely due to the recent surgery and possible bleeding and sepsis. No aspirin is given as it is felt the thrombocytosis was temporary and side effects were too great.
However, the story doesn’t end here. He recovers from the operation and follow up scans for his colorectal malignancy have shown no evidence of spread. The GP has been asked to monitor is FBC. Over the past nine months three FBC have been done and this is the latest:
- Hb 156g/L
- MCV 92fL
- WCC 10.7×10*9/L
- Neutrophils 6.2×10*9/L
- Platelets 698×10*9/L
The platelet count has been elevated on all three occasions greater than 500×10*9/L. A full examination has been performed and northing abnormal is detected. His weight is steady. CRP is <5mg/L and ESR is 18mm/hr. Ferritin is 92microg/L.
Questions:
- What is your next line of investigation?
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