Case 50 part 5 – update

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:


  • What do you see?
  • What is the diagnosis?


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