You have a 41 year old female with night sweats, splenomegaly and pancytopenia.
Differential diagnosis from #teamhaem are:
- Lymphoma e.g. splenic marginal zone lymphoma or hairy cell leukaemia or even a high grade lymphoma
- Myeloproliferative neoplasm e.g. myelofibrosis
- Metastatic malignancy
- Liver disease with portal hypertension
- Disseminated TB
- Acute viral infection e.g. EBV
- Tropical infections
- Lysosomal storage diseases (but would not cause these symptoms)
On the blood film you’d want to look for red cell changes – any signs of haemoglobinopathy or haemolysis. Any signs of hyposplenism. Any atypical lymphocytes e.g. hairy cells, villus lymphocytes. Any blasts.
This was a picture of the blood film:
Questions
- What do you see?
- What is the diagnosis?
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