The patient was diagnosed with community acquired pneumonia. He had a normal FBC six weeks ago and now has a neutrophilia and normocytic anaemia with monocytosis. Almost all of you were correct in identifying that the film showed left shift with toxic granulation/vacuolation. There was also some rouleaux and polychromasia. This was felt to be consistent with infection/inflammation. The patient was treated with intravenous antibotics and then discharged on oral antibiotics. A repeat FBC four weeks later showed normal numbers and morphology.
Identifying signs of infection on the blood film is key. Occasionally bacteria can also be seen!