Thanks for all of the suggestions! Here’s a slightly bigger picture of the nucleated red cell and tear drop poikilocytes:

The GP tells you the patient used to be under haematology review elsewhere but since moving locally has not been seen for three years. She has had change of bowel habit with some PR bleeding and the GP felt an abdominal mass. This was some routine blood testing to accompany a two week wait/urgent gastro-intestinal referral.

Questions:

• Other than myelofibrosis what else causes tear drop cells?
• Any other useful testing you could do to help before the patient attends for a marrow?

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