For the start of this case see below: https://teamhaem.wordpress.com/2013/10/21/case-16-october-2013-the-start/

There has been a discussion amongst the team about this patient.  Clearly more information is needed.  It was rightly pointed out that a full travel and social history is needed.  He is from Nigeria originally, but has been in the UK for the past eight years.  He works full time as a youth worker.  He has been back to Nigeria a number of times; the most recent eighteen months ago.  He has a long term partner and has not had another relationships.  He drinks alcohol excessively – 40-50 units per week and does not smoke.

Further history reveals feeling shivery for the last week and states has been hot at night at times.  No rashes or swellings.  Feels exercise tolerance has reduced.

The baseline bloods done in A&E include:

Na 133, K 4.1, Creat 98, urea 14.1, Ca 2.34, CRP 112, lactate 2.9

LFTs: ALP 190, bili 32, ALT 34, albumin 29

WCC 3.2, neuts 1.4, Hb 102g/L, PLT 110

He has been started on broad spectrum antibiotics following blood and urine cultures.  Co-amoxiclav intravenously is delivered as per local protocol along with IV Hartmann’s solution.  A CXR and stool culture plus OCP are requested.  After being seen by the medical SHO an HIV test is requested, along with thick and thin films for malaria.  He is due to be seen by the consultant on the PTWR in the morning.

Questions

• What worries you so far about this chap?
• What could be the underlying cause based on the above investigations?

Please reply on Twitter and always include #teamhaem to allow others to follow your comments. Please join in the debate and learn about haematological problems along the way. The case will continue to  evolve over the coming week so keep checking #teamhaem for more information.

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