Mr Ordie was referred to Haematology clinic after his initial investigations were unremarkable. Bhy this point his Hb was 85g/l with an MCV of 114fl, platelets of 107. A bone marrow biopsy was performed, which showed:

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IMAGE: dysplastic red cell precursors, dysplastic granulocyte precursors, blasts 3%.

The cytogenetics showed del(7q). This gave him a prognostic score of 3.6 using the IPSS-R, with a predicted survival of 3 years.

He was followed in clinic for 18 months, and after 6 months required regular transfusion.

On his most recent clinic visit he commented that he felt much more tired, and had developed a few cold sores that wouldn’t heal.

His bloods from this clinic showed:

Hb 89 g/l, MCV 88fl, WCC 23 x10*9, platelets 23.

What is going on now? What tests would you ask for next?

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