Thanks for all your hard work so far.
We’ve established that Mr Ordie has a macrocytic anaemia with normal thyroid function tests, normal B12 and folate and no significant alcohol history. He takes methotrexate and folic acid for rheumatoid arthritis. Methotrexate can cause a mild macrocytosis, or in overdose (intentional, due to drug interaction, or due to acute renal failure and accumulation) can cause a significant pancytopenia.
We then requested a blood film, which looked like this:
The formal report for this film was as follows:
“Mild macrocytic anaemia noted. Film contains frequent pseudo-pelger cells with occasional red cells containing basophilic stippling. Suggestive of myelodysplasia; referral to haematology is advised.”
Which tests might be done in the haematology clinic? How do they help to confirm the diagnosis?
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